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Frigerio M, V M Freire R, Soares TA, Amenitsch H, Leser ME, Salentinig S. Interfacial structurization between triolein and water from pH and buffer ions. J Colloid Interface Sci 2024; 665:1091-1101. [PMID: 38548506 DOI: 10.1016/j.jcis.2024.03.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 04/17/2024]
Abstract
HYPOTHESIS Understanding and manipulating the oil/water interface is important across various industries, including food, pharmaceuticals, cosmetics, and detergents. Many of these processes occur under elevated pH conditions in buffer systems, where base-catalyzed hydrolysis of triglyceride ester bonds leads to amphiphilic reaction products such as fatty acids. EXPERIMENTS Here, pH-triggered alterations of the triolein/water interface are analyzed in the presence of phosphate (PB) and tris(hydroxymethyl)aminomethane (TRIS). Ellipsometry at the liquid/liquid interface, tensiometry, and scanning small angle X-ray scattering are used to study the formation of structures at the oil/water interface. Confocal Raman microscopy, nuclear magnetic resonance spectroscopy, and in silico modeling analyze compositional changes in the interfacial region. FINDINGS pH and buffer ions were discovered to significantly modify the triglyceride/water interface, contrary to the decane/water control. Decreasing interfacial tensions from 32.4 to 2.2 mN/m upon pH increase from 6.5 to 9.5 is seen with multilamellar interfacial layers forming at pH around 9.0 in the presence of TRIS. Oleic acid from triolein hydrolysis and its further interaction with TRIS is held responsible for this. The new understanding can guide the design of pH- and ion-responsive functional materials and optimize industrial processes involving triglyceride/water interfaces.
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Affiliation(s)
- Matteo Frigerio
- Department of Chemistry, University of Fribourg, Chemin Du Musée 9, 1700 Fribourg, Switzerland
| | - Rafael V M Freire
- Department of Chemistry, University of Fribourg, Chemin Du Musée 9, 1700 Fribourg, Switzerland
| | - Thereza A Soares
- Department of Chemistry, FFCLRP, University of São Paulo, Ribeirão Preto-SP, Brazil; Hylleraas Centre for Quantum Molecular Sciences, University of Oslo, Oslo, Norway
| | - Heinz Amenitsch
- Institute for Inorganic Chemistry, Graz University of Technology, Stremayergasse 9/V, Graz 8010, Austria
| | - Martin E Leser
- Department of Chemistry, University of Fribourg, Chemin Du Musée 9, 1700 Fribourg, Switzerland
| | - Stefan Salentinig
- Department of Chemistry, University of Fribourg, Chemin Du Musée 9, 1700 Fribourg, Switzerland.
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Barba M, Cola A, Frigerio M. Intraoperative Fluorescent Ureter Visualization for Transvaginal High Uterosacral Ligament Suspension for Severe Pelvic Organ Prolapse. Int Urogynecol J 2024:10.1007/s00192-024-05816-1. [PMID: 38780627 DOI: 10.1007/s00192-024-05816-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/18/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION AND HYPOTHESIS We aimed to demonstrate the feasibility of ureteral navigation using intra-ureteric indocyanine green (ICG) and near-infrared fluorescence (NIRF) imaging during transvaginal high uterosacral ligament suspension for prolapse repair to reduce the risk of iatrogenic ureteral injury. METHODS A cystoscope was inserted into the bladder, the tip of a 6-F open-end ureteral catheter was inserted into the ureteral orifices, and ICG was instilled into the ureters. The ureteral path was then clearly identified using NIRF imaging. Sutures were safely placed in the uterosacral ligaments at the level of the ischial spine, taking advantage of direct ureteral visualization. RESULTS At the end of the procedure, diagnostic cystoscopy was performed to confirm ureteral patency. No intraoperative or postoperative complications were observed. CONCLUSIONS Intra-ureteric ICG-NIRF imaging represents a simple, inexpensive, and reproducible trick for intraoperative ureteral detection, and could reassure surgeons during difficult operations, for instance, in the case of severe prolapse and/or when ureteral course abnormalities are expected.
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Affiliation(s)
- Marta Barba
- Department of Gynecology, Fondazione IRCCS San Gerardo Dei Tintori-University of Milano-Bicocca, Via Pergolesi 33, Monza, Italy
| | - Alice Cola
- Department of Gynecology, Fondazione IRCCS San Gerardo Dei Tintori-University of Milano-Bicocca, Via Pergolesi 33, Monza, Italy
| | - Matteo Frigerio
- Department of Gynecology, Fondazione IRCCS San Gerardo Dei Tintori-University of Milano-Bicocca, Via Pergolesi 33, Monza, Italy.
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Bosio S, Perossini S, Torella M, Braga A, Salvatore S, Serati M, Frigerio M, Manodoro S. The association between vulvodynia and interstitial cystitis/bladder pain syndrome: A systematic review. Int J Gynaecol Obstet 2024. [PMID: 38655714 DOI: 10.1002/ijgo.15538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 03/10/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Vulvodynia (VVD) is a debilitating chronic vulvar pain significantly affecting patients' quality of life. Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic and complex illness characterized by an unpleasant sensation related to the filling of the bladder and it strongly impacts patients' lives. The exact mechanisms of the two syndromes remain unknown, but there is an overlap between suspected pathophysiologies. OBJECTIVE To present an overview of the current research on the association between VVD and IC/BPS. SEARCH STRATEGY A systematic search of three electronic databases was conducted. Studies examining the correlation between VVD and IC/BPS with male and female patients aged over 18 years were included. SELECTION CRITERIA Studies assessing the coexistence of VVD and IC/BPS were included. Reviews, letters to the editor, conference abstracts, book chapters, guidelines, Cochrane reviews, and expert opinions were excluded. DATA COLLECTION AND ANALYSIS Two reviewers screened the studies for eligibility. Eligible studies were screened for quality. MAIN RESULTS A total of 13 studies were included in the final review. Among them, 11 presented a positive association between the two syndromes. The studies highlighted that VVD and IC/BPS share common comorbidities and possibly etiopathogenic pathways. CONCLUSION VVD and IC/BPS are both complex and multifactorial syndromes. This review highlights an association between them, but additional studies on the topic should be conducted for a more precise conclusion.
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Affiliation(s)
- Sara Bosio
- ASST Franciacorta, Mellino Mellini Hospital, Chiari, Italy
| | - Silvia Perossini
- ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
- University of Milano, Milan, Italy
| | | | | | | | - Maurizio Serati
- Del Ponte Hospital, Varese, Italy
- Dell'Insubria University, Varese, Italy
| | | | - Stefano Manodoro
- ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
- University of Milano, Milan, Italy
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Morciano A, Marzo G, Schiavi MC, Zullo MA, Frigerio M, Tinelli A, Cervigni M, Scambia G. From 3D to 2D-4K laparoscopic sacral colpopexy: are we addicted to technology? MINIM INVASIV THER 2024:1-7. [PMID: 38648419 DOI: 10.1080/13645706.2024.2343855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE A study analyzing perioperative outcomes related to a sudden switch from 3D to 2D-4K technology for laparoscopic sacral colpopexy by expert pelvic surgeons: are we addicted to technology? MATERIAL AND METHODS After a sudden transition from 3D to 2D-4K laparoscopic technology, a total of 115 consecutive pelvic prolapse patients who underwent sacral colpopexy from June 2020 to September 2021 were retrospectively assessed from our database. Perioperative parameters, operative times (OT), and intraoperative difficulty scales were assessed. One-year follow-ups were analyzed for the study. Primary endpoints were OT; secondary endpoint was the evaluation of complications linked to this procedure. RESULTS We found statistical differences in OT and intraoperative difficulty scales between medians of the last 3D procedures and the first ten 2D-4K surgeries, without differences between operators. Only after more than 20 surgeries, we observed no significant differences between 3D and 2D-4K sacral colpopexy. We observed no statistical differences in terms of anatomic failure, PGI-I, and intra-postoperative complications. CONCLUSION The transition of urogynecology from an exclusive vaginal approach to 2D-3D-4K laparoscopy significantly increased the level of technology necessary for surgical treatment of prolapse. This could, as a result, lead to pelvic surgeons becoming increasingly dependent on technology.
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Affiliation(s)
- Andrea Morciano
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione "Card. G. Panico", Lecce, Italy
| | - Giuseppe Marzo
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione "Card. G. Panico", Lecce, Italy
| | | | - Marzio Angelo Zullo
- Department of Surgery-Week Surgery, "Campus Biomedico" University, Roma, Italy
| | - Matteo Frigerio
- Department of Obstetrics and Gynecology, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Andrea Tinelli
- Department of Gynaecology and Obstetrics, "Veris Delli Ponti" Hospital, Lecce, Italy
| | - Mauro Cervigni
- Department of Urology, "La Sapienza" University, ICOT-Latina, Latina, Italy
| | - Giovanni Scambia
- Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
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Barba M, Cola A, De Vicari D, Costa C, Volontè S, Frigerio M. How Old Is Too Old? Outcomes of Prolapse Native-Tissue Repair through Uterosacral Suspension in Octogenarians. Life (Basel) 2024; 14:433. [PMID: 38672705 PMCID: PMC11050946 DOI: 10.3390/life14040433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Medical advancements are expected to lead to a substantial increase in the population of women aged 80 and older by 2050. Consequently, a significant number of individuals undergoing corrective prolapse surgery will fall into the elderly-patient category. The research indicates a notable rise in complications associated with prolapse surgery in patients older than 80, irrespective of frailty and other risk factors. Despite these challenges, the vaginal approach has been identified as the safest surgical method for pelvic organ prolapse (POP) repair in the elderly population. For this reason, we aimed to investigate the efficacy, complication rate, and functional outcomes associated with vaginal hysterectomy and an apical suspension/high uterosacral ligaments suspension as a primary technique for prolapse repair, both within a cohort of elderly patients. METHODS We retrospectively analyzed patients who underwent transvaginal hysterectomy plus an apical suspension procedure for stage ≥ II and symptomatic genital prolapse between January 2006 and December 2013. Anatomical and functional outcomes were evaluated. The Patient Global Impression of Improvement (PGI-I) score was used to evaluate subjective satisfaction after surgery. RESULTS Sixty-five patients were included in the analysis. The median age was 81.3 years. All individuals exhibited an anterior compartment prolapse stage II or higher, and the majority also a central prolapse stage II or higher. Notably, all participants reported symptoms of vaginal bulging. Over half of the population (58.6%) complained of incomplete bladder emptying. The intervention for all participants involved a vaginal hysterectomy with an apical suspension. Sixty-three patients (96.9%) and forty-four patients (67.6%) underwent a simultaneous anterior or posterior repair, respectively. Long-term complications (>30 days from surgery) were observed during follow-up, with a median duration of 23 ± 20 months. Seven (10.7%) anatomical recurrences were recorded, five (7.69%) concerning the anterior compartment, one (1.5%) the central, and three (4.6%) the posterior. Nevertheless, none of them necessitated further surgical intervention due to symptoms. Significant anatomical improvements for the anterior, central, and posterior compartments were noticed, compared to preoperative assessment (p < 0.001 for Aa and Ba, p < 0.001 for Ap and Bp, and p < 0.001 for C). PGI-I values established that 100% of patients were satisfied (PGI-I ≥ 2), with a median score of 1.12. Consequently, objective and subjective cure rates were 89.5% and 100%, respectively. CONCLUSION Vaginal hysterectomy combined with apical suspension, particularly high uterosacral ligaments suspension, is a safe and effective primary surgical approach, even in elderly patients.
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Affiliation(s)
| | | | | | | | | | - Matteo Frigerio
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (D.D.V.); (C.C.); (S.V.)
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Barba M, Cola A, De Vicari D, Melocchi T, Gili MA, Frigerio M. Enhanced recovery after surgery (ERAS) in prolapse repair: A prospective study on pre-emptive uterosacral/cervical block. Int J Gynaecol Obstet 2024. [PMID: 38516832 DOI: 10.1002/ijgo.15483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/22/2024] [Accepted: 03/10/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE Enhanced recovery after surgery (ERAS) protocols have been introduced in gynecology. Postoperative pain management after vaginal procedures remains a relevant issue. In the present study we aimed to evaluate the effectiveness of pre-emptive uterosacral/cervical block (PUCB) for postoperative pain control in patients with uterovaginal prolapse undergoing vaginal hysterectomy and pelvic floor repair. We also evaluated the impact on the length of recovery. METHODS This was a pilot study analyzing 40 women who underwent pelvic organ prolapse repair through uterosacral ligament suspension. Patients who chose to undergo PUCB were considered as cases, otherwise as controls. After general or spinal anesthesia induction, the treatment group received the PUCB with ropivacaine plus clonidine injections at 2, 4, 8, and 10 o'clock of the cervix. The control group did not receive additional treatment. Pain intensity was measured at rest and after forceful cough at 1, 4, 8, 12, 24, and 48 h postoperatively. RESULTS We found a significant reduction in pain values at 1 h (rest and forceful cough) and 24 h (forceful cough) in the PUCB group. The incidence of moderate/severe pain was inferior in the PUCB group at 1 h (rest) and 24 h (rest and forceful cough). There were no differences in terms of the use of rescue opioids (0% vs. 5%; P = 0.311) and length of hospital stay (2.5 ± 0.6 vs. 2.3 ± 0.6; P = 0.180). CONCLUSIONS For the first time, we demonstrated the impact of pre-emptive uterosacral/cervical block on pain control up to 24 h after surgery. Clonidine as a sensory blockade extender appears promising in enhancing the efficacy of local anesthetics.
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Affiliation(s)
- Marta Barba
- Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Alice Cola
- Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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Tinelli A, Yassa M, Marzo G, Romualdi D, Frigerio M, Melcarne A, Scambia G, Pecorella G, Morciano A. Spondylodiscitis after sacral colpopexy: diagnose early to treat earlier. Int J Clin Exp Pathol 2024; 17:90-95. [PMID: 38577696 PMCID: PMC10988091 DOI: 10.62347/rerc7901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/21/2024] [Indexed: 04/06/2024]
Abstract
Spondylodiscitis following sacral colpopexy for Pelvic Organ Prolapse (POP) represents a rare complication with severe consequences. Authors performed a literature search, from 2000 to 2022, to set a narrative review of literature. Spondylodiscitis is an uncommon but dangerous side effect of a routine surgical treatment that needs to be identified and treated right away to prevent worsening clinical consequences. Suboptimal dissection of the sacral promontory and/or site infection are associated with spondylodiscitis. When spondylodiscitis is suspected, advanced imaging methods should be used, and surgical excision shouldn't be put off after a failed course of treatment. Authors presented a case-video of a 68-year-old woman who reported severe lower back pain 7 weeks after surgery, in which sacral spondylodiscitis was diagnosed and laparoscopically treated. In this case, a laparoscopic tack and mesh removal from promontory was carried out following the patient's continued lower back pain and the antibiotic therapy's incomplete radiological remission of spondylodiscitis. The patient's radiological findings and symptoms completely resolved two weeks following the procedure.
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Affiliation(s)
- Andrea Tinelli
- Department of Gynaecology and Obstetrics, “Veris Delli Ponti” Hospital, and CERICSAL (CEntro di RIcerca Clinico SALentino), “Veris delli Ponti Hospital”Scorrano, Lecce, Italy
| | - Murat Yassa
- Department of Obstetrics and Gynecology, Sağlık Bilimleri Üniversitesi, Şişli Etfal Hastanesiİstanbul, Turkey
| | - Giuseppe Marzo
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione “Card. G. Panico”Tricase, Italy
| | - Daniela Romualdi
- Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario “A. Gemelli” - IRCCS, Università Cattolica del Sacro CuoreRoma, Italy
| | - Matteo Frigerio
- Department of Obstetrics and Gynecology, ASST Monza, San Gerardo HospitalMonza, Italy
| | - Alessio Melcarne
- Department of Radiology, Pia Fondazione “Card. G. Panico”Tricase, Italy
| | - Giovanni Scambia
- Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario “A. Gemelli” - IRCCS, Università Cattolica del Sacro CuoreRoma, Italy
| | - Giovanni Pecorella
- Department of Obstetrics, Gynecology and Reproductive Medicine, Saarland UniversityKirrbergerstraße 100, Gebäude 9, 66421 Homburg/Saar, Germany
| | - Andrea Morciano
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione “Card. G. Panico”Tricase, Italy
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Barba M, Cola A, Costa C, Frigerio M. Impact of Mannitol Bladder Distension in the Intraoperative Detection of Ureteral Kinking During Pelvic Floor Surgery. Int Urogynecol J 2024; 35:689-694. [PMID: 38393333 PMCID: PMC11024013 DOI: 10.1007/s00192-024-05745-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/16/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Ureteral injuries are the most feared complications of gynecological surgery and therefore intraoperative recognition is of the utmost importance. Intraoperative cystoscopy represents the diagnostics of choice to investigate ureteral patency thanks to the direct visualization of ureteral flows after administration of infusion mediums. In this study, we aimed to compare the diagnostic performance of saline versus mannitol intraoperative cystoscopy in terms of false negatives in a large cohort of patients. METHODS We retrospectively analyzed data of patients who underwent vaginal hysterectomy and high uterosacral ligament suspension for POP. Patients were divided in two groups based on the use of saline or mannitol medium for intraoperative cystoscopy. Postoperative daily control of serum creatinine was performed until discharge, as well as urinary tract imaging, in symptomatic patients. RESULTS A total of 925 patients underwent vaginal hysterectomy followed by high USL suspension for POP. Saline and mannitol medium were used in 545 patients and 380 patients respectively. Postoperative ureteral injuries were identified in 12 patients, specifically in 2% of the saline group and in 0.3% of the mannitol group. CONCLUSIONS The use of mannitol instead of saline as a bladder distension medium was able to significantly reduce the occurrence of postoperative ureteral sequelae.
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Affiliation(s)
- Marta Barba
- Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Alice Cola
- Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Clarissa Costa
- Milano-Bicocca University, Via G.B. Pergolesi 33, 20900, Monza, Italy.
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Barba M, Cola A, Melocchi T, De Vicari D, Costa C, Volontè S, Sandullo L, Frigerio M. High Uterosacral Ligaments Suspension for Post-Hysterectomy Vaginal Vault Prolapse Repair. Medicina (Kaunas) 2024; 60:320. [PMID: 38399607 PMCID: PMC10890601 DOI: 10.3390/medicina60020320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Uterosacral ligaments (USLs) suspension is a well-studied, safe, and long-lasting technique for central compartment correction. Preliminary clinical experiences showed encouraging data for this technique, also for post-hysterectomy vaginal vault prolapse surgical treatment. However, up-to-date evidence for post-hysterectomy vaginal vault prolapse repair through high uterosacral ligaments suspension is limited. Consequently, with this study, we aimed to assess the efficiency, complications frequency, and functional results of native-tissue repair through USLs in vaginal vault prolapse. Materials and Methods: This was a retrospective study. Women with symptomatic vaginal vault prolapse (≥stage 2) who underwent surgery with transvaginal native-tissue repair by high uterosacral ligaments were included. Patient characteristics, preoperative assessment, operative data, postoperative follow-up visits, and re-interventions were collected from the hospital's record files. High uterosacral ligament suspension was performed according to the technique previously described by Shull. A transverse apical colpotomy at the level of the post-hysterectomy scar was performed in order to enter the peritoneal cavity. USLs were identified and transfixed from ventral to dorsal with three absorbable sutures. Sutures were then passed through the vaginal apex and tightened to close the transverse colpotomy and suspend the vaginal cuff. At the end of the surgical time, a diagnostic cystoscopy was performed in order to evaluate ureteral bilateral patency. Using the POP-Q classification system, we considered an objective recurrence as the descensus of at least one compartment ≥ II stage, or the need for a subsequent surgery for POP. The complaint of bulging symptoms was considered the item to define a subjective recurrence. We employed PGI-I scores to assess patients' satisfaction. Results: Forty-seven consecutive patients corresponding to the given period were analyzed. No intraoperative complications were observed. We observed one postoperative hematoma that required surgical evacuation. Thirty-three patients completed a minimum of one-year follow-up (mean follow-up 21.7 ± 14.6 months). Objective cure rate was observed in 25 patients (75.8%). No patients required reintervention. The most frequent site of recurrence was the anterior compartment (21.2%), while apical compartment prolapse relapsed only in 6% of patients. An improvement in all POP-Q parameters was recorded except TVL which resulted in a mean 0.5 cm shorter. Subjective recurrence was referred by 4 (12.1%) patients. The mean satisfaction assessed by PGI-I score was 1.6 ± 0.8. Conclusion: This analysis demonstrated that native-tissue repair through high USL suspension is an effective and safe procedure for the treatment of post-hysterectomy vaginal vault prolapse. Objective, subjective, functional, and quality of life outcomes were satisfactory, with minimal complications.
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Affiliation(s)
- Marta Barba
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (T.M.); (D.D.V.); (C.C.); (S.V.)
| | - Alice Cola
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (T.M.); (D.D.V.); (C.C.); (S.V.)
| | - Tomaso Melocchi
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (T.M.); (D.D.V.); (C.C.); (S.V.)
| | - Desirèe De Vicari
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (T.M.); (D.D.V.); (C.C.); (S.V.)
| | - Clarissa Costa
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (T.M.); (D.D.V.); (C.C.); (S.V.)
| | - Silvia Volontè
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (T.M.); (D.D.V.); (C.C.); (S.V.)
| | - Lucia Sandullo
- Department of Gynecology, Università della Campania Luigi Vanvitelli, 81100 Caserta, Italy;
| | - Matteo Frigerio
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (T.M.); (D.D.V.); (C.C.); (S.V.)
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Frigerio M, Barba M, Palmieri S, Ruffolo AF, Gallo P, Magoga G, Manodoro S, Vergani P. Prevalence and severity of sexual disorders in the third trimester of pregnancy. Minerva Obstet Gynecol 2024; 76:21-26. [PMID: 35686638 DOI: 10.23736/s2724-606x.22.05118-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Female sexual function in pregnancy is an under-investigated topic by care providers. This study aimed to investigate the sexual function and the impact of traditional risk factors for pelvic floor disorders (PFDs) during the third trimester of pregnancy. METHODS This is a secondary analysis of a multicenter cross-sectional study conducted in eight hospitals in Italy and Italian-speaking Switzerland. Women at the third trimester of pregnancy aged 18 years and over completed the Italian-PFQPP questionnaire anonymously. RESULTS Overall, 927 patients in the third trimester of pregnancy answered the questionnaire. About 29.5% of women reported reduced or absent sexual activity. The less reported symptom was coital incontinence (1.3%), while painful intercourses was the most frequent one (50.3%). Nicotine abuse was associated with traumatic sexual intercourses, impaired vaginal sensibility, and negative impact on sexual life and well-being. Familiarity for pelvic floor disorder resulted as a risk factor for coital incontinence (OR=3.61). CONCLUSIONS Sexual symptoms, with pain during intercourses being the most widely reported, are extremely common in the third trimester of pregnancy and can greatly affect quality of life. Familiarity for pelvic floor disorders and nicotine abuse resulted as significant risk factors for at least one sexual symptom.
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Affiliation(s)
- Matteo Frigerio
- ASST Monza, San Gerardo Hospital, Monza, Monza-Brianza, Italy
| | - Marta Barba
- Milano-Bicocca University, Monza, Monza-Brianza, Italy -
| | | | | | | | - Giulia Magoga
- ULSS2 Marca Trevigiana, Oderzo Hospital, Oderzo, Treviso, Italy
| | | | - Patrizia Vergani
- Obstetrics Division, Monza and Brianza Mother and Child Foundation, Monza, Monza-Brianza, Italy
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Morciano A, Schiavi MC, Frigerio M, Licchetta G, Tinelli A, Cervigni M, Marzo G, Scambia G. Quality of Life and Sexual Function after Laparoscopic Posterior Vaginal Plication Plus Sacral Colpopexy for Severe Posterior Vaginal Prolapse. J Clin Med 2024; 13:616. [PMID: 38276122 PMCID: PMC10816297 DOI: 10.3390/jcm13020616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/19/2023] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Laparoscopic sacral colpopexy (LSC) is the gold standard treatment for women with apical/anterior pelvic organ prolapse (POP). For isolated posterior vaginal prolapse, instead, the literature suggests fascial native tissue repair. This is a retrospective 2-year quality-of-life follow-up study after laparoscopic posterior plication (LPP) combined with LSC in patients with anterior/apical prolapse combined with severe posterior colpocele. The primary endpoint was to evaluate the subjective outcomes quality of life (QoL), sexual function, and patient satisfaction rate. The secondary endpoint was to evaluate perioperative and anatomical outcomes at the 2-year follow-up. METHODS A total of 139 consecutive patients with anterior and/or apical prolapse (POP-Q stage ≥ II) and severe posterior vaginal prolapse (posterior POP-Q stage ≥ III) were retrospectively selected from our database among women who underwent, from November 2018 to February 2021, a "two-meshes" LSC. The patients were classified into Group A (81 patients; LSC plus LPP) and Group B (67 patients; LSC alone). The primary endpoint was evaluated using the Patient Global Impression of Improvement (PGI-I), the Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6), the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), the Female Sexual Distress Scale (FSDS), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), and the EuroQol (EQ-5D). The secondary endpoint was studied using the POP-Q study and an intra-, peri-, and post-operative complications assessment. Two-year follow-up data were analyzed for the study. RESULTS At 2 years, all women showed a statistically significant amelioration of their symptoms on the QoL questionnaires. We found a statistical difference in favor of posterior plication in terms of the PGI-I successful outcome rate (Group A versus B: 85.3% versus 67.1%), FSDS (median 11 versus 21), and PISQ-12 (median 89 versus 62) (p < 0.05 for all comparisons). A significant improvement of all EQ-5D values was observed from baseline to 2-year follow-up, and only for the "pain/discomfort" domains did we observe a significant improvement in LSC plus LPP patients versus LSC alone (p < 0.05). LSC plus LPP women showed, at 2 years, a significant amelioration of their Ap and GH POP-Q points. We observed no statistical differences in terms of intra-post-operative complications or anatomic failure rate between groups. CONCLUSIONS Our LPP approach to LSC appears to be a safe, feasible, and effective treatment for advanced pelvic organ prolapse with a significant impact on the patient's general health and sexual quality of life. Adding laparoscopic posterior vaginal plication to "two-meshes" sacral colpopexy is recommended in patients with apical/anterior prolapse and concomitant severe posterior colpocele. This surgical approach, in addition to improving the anatomical results of these patients, is associated with a significant improvement in sexual and quality of life indexes.
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Affiliation(s)
- Andrea Morciano
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione “Card. G. Panico”, 73039 Tricase, Italy; (G.L.); (G.M.)
- AIUG Research Group, Associazione Italiana di UroGinecologia e del Pavimento Pelvico, 00168 Roma, Italy; (M.C.S.); (M.F.); (M.C.)
| | - Michele Carlo Schiavi
- AIUG Research Group, Associazione Italiana di UroGinecologia e del Pavimento Pelvico, 00168 Roma, Italy; (M.C.S.); (M.F.); (M.C.)
- Department of Gynaecology and Obstetrics, “Sandro Pertini” Hospital, 00157 Roma, Italy
| | - Matteo Frigerio
- AIUG Research Group, Associazione Italiana di UroGinecologia e del Pavimento Pelvico, 00168 Roma, Italy; (M.C.S.); (M.F.); (M.C.)
- Department of Obstetrics and Gynecology, ASST Monza, San Gerardo Hospital, 20900 Monza, Italy
| | - Giulio Licchetta
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione “Card. G. Panico”, 73039 Tricase, Italy; (G.L.); (G.M.)
- AIUG Research Group, Associazione Italiana di UroGinecologia e del Pavimento Pelvico, 00168 Roma, Italy; (M.C.S.); (M.F.); (M.C.)
| | - Andrea Tinelli
- Department of Gynaecology and Obstetrics, “Veris Delli Ponti Hospital”, 73020 Scorrano, Italy;
| | - Mauro Cervigni
- AIUG Research Group, Associazione Italiana di UroGinecologia e del Pavimento Pelvico, 00168 Roma, Italy; (M.C.S.); (M.F.); (M.C.)
- Department of Urology, Università “La Sapienza”, ICOT-Latina, 00161 Roma, Italy
| | - Giuseppe Marzo
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione “Card. G. Panico”, 73039 Tricase, Italy; (G.L.); (G.M.)
| | - Giovanni Scambia
- Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario “A. Gemelli”, Università Cattolica del Sacro Cuore, 00168 Roma, Italy;
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Frigerio M, Barba M, Marino G, Volonte S, Cola A. Pelvic floor ultrasound evaluation in the diagnosis of exposure of synthetic implanted materials in the lower urinary tract. Int J Gynaecol Obstet 2023; 163:834-839. [PMID: 37332147 DOI: 10.1002/ijgo.14933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 04/29/2023] [Accepted: 05/28/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE To evaluate the diagnostic performance of pelvic floor ultrasound (PFUS) to recognize prosthetics exposure in the bladder and/or urethra in women with lower urinary tract symptoms (LUTS). METHODS A cross-sectional study evaluating patients with LUTS after mesh/sling surgery. PFUS was performed with both transvaginal (TVUS) and translabial (TLUS) approaches. A distance of 1 mm or less from the bladder and/or urethra was considered highly suspect for mesh exposure. After PFUS, patients underwent diagnostic urethrocystoscopy. RESULTS A total of 100 consecutive women were analyzed. According to urethrocystoscopy, the rate of tape exposure in the lower urinary tract was 3%. PFUS showed 100% sensitivity and 98%-100% specificity in detecting lower urinary tract mesh exposure. The negative predictive value was 100% and the positive predictive value ranged from 33% to 50% for urethral and 100% for bladder exposure. CONCLUSIONS PFUS represents an effective and reliable non-invasive screening test to exclude prosthetics exposure in the bladder and/or urethra in women with LUTS.
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Affiliation(s)
| | | | | | | | - Alice Cola
- Monza-Ospedale San Gerardo, Monza, Italy
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Barba M, Cola A, Rezzan G, Costa C, Re I, Volontè S, Terzoni S, Frigerio M, Maruccia S. Flat Magnetic Stimulation for Urge Urinary Incontinence. Medicina (Kaunas) 2023; 59:1999. [PMID: 38004048 PMCID: PMC10673601 DOI: 10.3390/medicina59111999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/30/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Strategies for overactive bladder syndrome (OAB) management involve, among others, strengthening the bladder outlet to suppress urgency and neuromodulating the sacral roots. Magnetic stimulation (MS) is a technology that involves an extracorporeal device that is able to provide an electromagnetic field specifically designed to interact with pelvic floor neuromuscular tissue. The resulting tissue electrical activity induces contraction of the pelvic muscle and neuromodulation of the S2-S4 sacral roots. Flat Magnetic Stimulation (FMS) is a relevant advancement involving homogeneous electromagnetic fields, which are able to optimize the effect on the entire pelvic area. However, the benefits of this new technology for OAB syndrome are poorly known. Consequently, the aim of our study is to analyze the outcomes and quality of life (QoL) impact of FMS with Dr. Arnold (DEKA, Calenzano, Italy) in women suffering from OAB syndrome associated with urinary incontinence. Materials and Methods: This prospective study included patients with OAB, urge urinary incontinence, and no ongoing OAB treatments. At baseline (T0), the Incontinence Impact Questionnaire (IIQ-7), the Female Sexual Function Index (FSFI-19), and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) were collected. Patients underwent 8 FMS sessions of 25 min each in one month. At the termination of the therapy (T1), women repeated the ICIQ-UI SF, FSFI-19, and IIQ-7 tools. Moreover, the Patient Global Impression of Improvement (PGI-I) questionnaire was collected to evaluate the cure rate. Results: Our study enrolled a total of 57 consecutive patients. Most women had at least one second- or third-line treatment before FMS, while the remaining naive patients had contraindications to pharmacological treatments. No women reported adverse effects during the treatment. After the treatment, we observed a decrease in the IIQ-7 (p < 0.001) and ICIQ-UI SF scores (p < 0.001) and an improvement in sexual function (p < 0.001) evaluated with FSFI-19. According to PGI-I scores, 42 (73.7%) women referred to some kind of improvement, scoring ≤ 3 points. Specifically, 8.7% of patients considered themselves very much improved, 29.8% much improved, 35.1% minimally improved, and 26.3% found no changes. FMS was effective in treating OAB symptoms without any adverse effects. The mechanism is supposed to be related to suppressing the initiation of micturition. This makes FMS a promising device for treating naive and refractory urge urinary incontinence. Conclusions: The new FMS represents a promising non-pharmacological option for the treatment of naive and refractory OAB.
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Affiliation(s)
- Marta Barba
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Alice Cola
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Giorgia Rezzan
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Clarissa Costa
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Ilaria Re
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Silvia Volontè
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Stefano Terzoni
- Department of Urology, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milano, Italy; (S.T.); (S.M.)
| | - Matteo Frigerio
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Serena Maruccia
- Department of Urology, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milano, Italy; (S.T.); (S.M.)
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Costa C, Barba M, Cola A, Frigerio M. Transvaginal excision of vaginal paraurethral leiomyoma: A video case report. Eur J Obstet Gynecol Reprod Biol 2023; 290:11-13. [PMID: 37708657 DOI: 10.1016/j.ejogrb.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/22/2023] [Accepted: 09/09/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Vaginal leiomyomas are uncommon benign tumors of the genital district that appear as a circumscribed, mobile, and nontender mass along the vaginal tube. The gold standard of vaginal leiomyoma management is surgical treatment. We aimed to present a clinical case of vaginal leiomyoma successfully treated throughout a transvaginal excision and layered repair. METHODS A 44-year-old woman was referred to our division for vaginal bulging symptoms and dyspareunia. Clinical examination revealed a 4-5 cm hard bulging mass in the anterior vaginal wall, below the urethra, compatible with vaginal leiomyoma. After proper counseling, the patient was admitted to transvaginal leiomyoma excision plus primary layered repair. RESULTS No surgical complications were observed. The indwelling catheter was removed the day after the surgery. The patient was successfully discharged home on postoperative day 1. The patient is currently asymptomatic and there are no signs of recurrence. CONCLUSION The procedure was successful in obtaining anatomical repair and relieving symptoms. This approach represents a valid procedure for the surgical management of this uncommon condition.
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Affiliation(s)
- Clarissa Costa
- Obstetrics and Gynecology Department, University of Milano-Bicocca, Monza, Italy.
| | - Marta Barba
- Obstetrics and Gynecology Department, University of Milano-Bicocca, Monza, Italy
| | - Alice Cola
- Department of Gynecology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Matteo Frigerio
- Department of Gynecology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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Barba M, Cola A, De Vicari D, Costa C, Castelli AP, Volontè S, Fruscio R, Frigerio M. Efficacy of a Diode Vaginal Laser in the Treatment of the Genitourinary Syndrome of Menopause. Bioengineering (Basel) 2023; 10:1158. [PMID: 37892888 PMCID: PMC10603982 DOI: 10.3390/bioengineering10101158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/16/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Genitourinary syndrome of menopause (GSM) and vulvovaginal atrophy (VVA) are the most frequent menopause-related clinical entities and are consistently included in the definition of pelvic floor disorders (PFDs). Nonhormonal therapies, such as lubricants and moisturizers, are indicated as first-line treatments, while the "gold standard'' is represented by topical estrogen products; however, in cancer survivors hormonal treatment is not indicated. For this reason, energy-based therapeutic approaches-for instance, through laser technologies-may be employed as alternative options in this kind of patient; however, there are no studies evaluating the efficacy of a pure diode vaginal laser in the treatment of GSM. As a consequence, with our study, we aimed to evaluate outpatient nonablative diode laser treatment in sexually active women, with contraindications, no response, or refusal of local estrogenic therapy. METHODS This prospective study included patients with GSM, aged ≥ 18 years old, with contraindications, or refusal of local estrogen therapies. Women were evaluated via the use of their Vaginal Health Index (VHI) scores, which consists of five measures: elasticity, fluid volume, pH, epithelial integrity, and moisture. Moreover, the intensity of VVA symptoms (vaginal burning, vaginal itching, vaginal dryness, dyspareunia, and dysuria) was measured using a 10 cm visual analog scale (VAS), where the left extreme of the scale (score = 0) indicated "absence of symptom" and the right indicated "symptom as bad as it could be" (score = 100). Sexual function was evaluated with the Female Sexual Function Index (FSFI-19) questionnaire. The treatment was performed using a Leonardo Dual diode laser (Biolitec Italia Srl, Milano, Italy). The laser treatment consisted of three sessions, one per month. One month after the third session, the VHI, symptom VAS, and FSFI-19 were re-evaluated. In addition, the Patient Global Impression of Improvement (PGI-I) questionnaire was collected. RESULTS Our study enrolled a total of 26 consecutive patients. All patients were either in menopause or under treatment with gonadotropin-releasing hormone (GnRH). None of the patients reported adverse effects after laser treatment. In total, 19 (73.1%) patients referred improvements of their symptoms according to PGI-I scores. All domains of the FSFI-19 questionnaire, significantly improved after the diode laser treatment. The mean VHI score increased by 3.2 points, from 12.2 to 15.4 (p < 0.001). Additionally, we documented a significant improvement in symptoms affecting the VAS score, from 69.2 to 43.5 points (p < 0.001). CONCLUSION A diode vaginal laser is an effective and easily tolerated ambulatory procedure for vaginal functional restoration in the treatment of GSM and VVA.
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Affiliation(s)
- Marta Barba
- Department of Gynecology, IRCC San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (D.D.V.); (C.C.); (S.V.); (R.F.)
| | - Alice Cola
- Department of Gynecology, IRCC San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (D.D.V.); (C.C.); (S.V.); (R.F.)
| | - Desirèe De Vicari
- Department of Gynecology, IRCC San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (D.D.V.); (C.C.); (S.V.); (R.F.)
| | - Clarissa Costa
- Department of Gynecology, IRCC San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (D.D.V.); (C.C.); (S.V.); (R.F.)
| | | | - Silvia Volontè
- Department of Gynecology, IRCC San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (D.D.V.); (C.C.); (S.V.); (R.F.)
| | - Robert Fruscio
- Department of Gynecology, IRCC San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (D.D.V.); (C.C.); (S.V.); (R.F.)
| | - Matteo Frigerio
- Department of Gynecology, IRCC San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (D.D.V.); (C.C.); (S.V.); (R.F.)
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Frigerio M, D'Alessandro G, Re I, Cola A, Vergani P, Barba M. Clinical, ultrasonographic, and functional outcomes after obstetric anal sphincter injury primary repair: A single-center experience. Int J Gynaecol Obstet 2023; 163:234-242. [PMID: 37128949 DOI: 10.1002/ijgo.14819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/14/2022] [Accepted: 04/12/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To present clinical and instrumental sequelae after obstetric anal sphincter injuries (OASIS), evaluating correlations between intrapartum severity of lesions, postpartum symptoms, and sonographic and manometric findings; outcomes during subsequent deliveries were also evaluated. METHODS This retrospective study evaluated all consecutive women who sustained an OASIS between 2015 and 2020. Postpartum symptoms, anorectal manometry (ARM), and three-dimensional endoanal ultrasonography (3D-EAUS) were analyzed. RESULTS A total of 107 women underwent OASIS primary repair; 84 (78.5%) of them were asymptomatic after 1 month. The presence and severity of symptoms showed a great correlation with instrumental outcomes in terms of maximum resting pressure, squeeze pressure increment (SPI), circumferential extension of defect for both external anal sphincter (EAS) and internal anal sphincter (IAS), and EAS, IAS and total Starck scores. There was a significant correlation between ARM and 3D-EAUS findings, with the exception of SPI, for which the abnormalities were not predictable based on EAUS results. CONCLUSION Both ARM and EAUS findings after OASIS are directly related to each other, and associated with symptoms. These instrumental tools may be useful for OASIS assessment and counseling.
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Affiliation(s)
| | | | - Ilaria Re
- University of Milano-Bicocca, Monza, Italy
| | - Alice Cola
- ASST Monza, Ospedale San Gerardo, Monza, Italy
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Frigerio M, Barba M, Marino G, Volontè S, Cola A. Intraoperative ultrasound assessment of ureteral patency after uterosacral ligaments apical suspension for prolapse surgical repair: A feasibility study. Int J Gynaecol Obstet 2023; 163:103-107. [PMID: 37171026 DOI: 10.1002/ijgo.14847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To prospectively compare power Doppler ultrasound diagnostic performance with reference standard cystoscopy in evaluating ureteral patency in a population at high risk of ureteral lesions. METHODS We analyzed 100 women who underwent pelvic organ prolapse repair. All ultrasound scans were obtained, at the end of the procedures, before cystoscopic evaluation. Bilateral simultaneous ureteral jet evaluation with power Doppler was performed at the level of the ureterovesical junctions with a pulse repetition frequency set to detect low flow for a maximum of 3 min. RESULTS According to the reference standard urethrocystoscopy, at least one ureter not ejaculating was observed in 6% of patients, for a total of seven ureters jets not visualized. No false-negative results were obtained. Ultrasound with power Doppler showed 100% sensitivity and 95.9% specificity in detecting the lack of ureteral jet. The negative predictive value was 100%, and the positive predictive value was 46.7%. CONCLUSIONS Ultrasound with power Doppler represents an effective and reliable non-invasive screening test to exclude ureteral kinking and reduce the need for intraoperative cystoscopy.
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Affiliation(s)
| | - Marta Barba
- University of Milano-Bicocca, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giuseppe Marino
- University of Milano-Bicocca, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Silvia Volontè
- University of Milano-Bicocca, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Alice Cola
- Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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Barba M, Cola A, Melocchi T, Braga A, Castronovo F, Manodoro S, Pennacchio M, Munno GM, Ruffolo AF, Degliuomini RS, Salvatore S, Torella M, Frigerio M. Italian validation of the Pelvic Floor Distress Inventory (PFDI-20) questionnaire. Int Urogynecol J 2023; 34:2459-2465. [PMID: 37195425 DOI: 10.1007/s00192-023-05572-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 04/27/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The use of validated Quality of Life (QoL) questionnaires is useful in the standardization and interpretation process of pelvic floor patient symptoms, due to their functional nature and high prevalence. The Pelvic Floor Distress Inventory QoL questionnaire (PFDI-20) serves both as a symptom inventory and a measure of the degree of bother and distress caused by pelvic floor symptoms. It includes items related to pelvic organ prolapse and lower gastrointestinal and bladder dysfunction. METHODS After consensus translation and a comprehension test, the Italian version of the questionnaire was submitted to patients reporting bowel, bladder, or pelvic disorders (cases) and to asymptomatic women (controls). Cases received the questionnaire once again 2 weeks later by email. RESULTS A total of 254 patients answered the questionnaire. Construct validity was demonstrated by discriminating between cases and controls. Convergent validity was demonstrated for each domain (F < 0.001). In-ernal consistency reliability showed a satisfactory range (0.816-0.860). CONCLUSIONS The PFDI-20 allows a comprehensive assessment of the effect of pelvic floor disorders on the quality of life of women. Moreover, the PFDI-20 represents a very solid QoL tool, since it has been extensively used in literature, and its use is highly recommended by the International Consultation on Incontinence. The present study demonstrated good features for the Italian version of the PFDI-20 questionnaire.
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Affiliation(s)
| | - Alice Cola
- Gynecology Unit, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | | | - Andrea Braga
- EOC Beata Vergine, Mendrisio, Switzerland
- Italian Urogynecology - Pelvic Floor Work Group (GLUP), Monza, Italy
| | | | - Stefano Manodoro
- Italian Urogynecology - Pelvic Floor Work Group (GLUP), Monza, Italy.
- ASST Santi Paolo E Carlo, San Paolo University Hospital, University of Milano, Via Antonio Di Rudinì 8, 20142, Milan, Italy.
| | - Marika Pennacchio
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gaetano Maria Munno
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro Ferdinando Ruffolo
- Vita-Salute San Raffaele University, Milan, Italy
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rebecca Susanna Degliuomini
- Vita-Salute San Raffaele University, Milan, Italy
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Salvatore
- Vita-Salute San Raffaele University, Milan, Italy
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Torella
- Italian Urogynecology - Pelvic Floor Work Group (GLUP), Monza, Italy
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Matteo Frigerio
- Gynecology Unit, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
- Italian Urogynecology - Pelvic Floor Work Group (GLUP), Monza, Italy
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Bosio S, Frigerio M, Barba M, Ruffolo AF, Gallo P, Magoga G, Manodoro S. Prevalence and severity of lower urinary tract symptoms in the third trimester of pregnancy. Int Urogynecol J 2023; 34:2155-2161. [PMID: 37014397 DOI: 10.1007/s00192-023-05515-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/19/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Pregnancy is a risk factor for urinary disorders, mainly in the third trimester. Lower urinary tract symptoms (LUTS) are often underreported by health care professionals and significantly impact the quality of life of pregnant women. Our objective is to analyse lower urinary tract function during the third trimester of pregnancy and assess the impact of traditional risk factors for pelvic floor dysfunctions on bladder health in pregnant women. METHODS This is a secondary analysis of a multicentre cross-sectional study. Third-trimester pregnant women aged 18 years or older anonymously filled in the "Italian Pelvic Floor Questionnaire for pregnant and postpartum women" questionnaire, validated for pelvic floor disorders in pregnancy and postpartum. RESULTS A total of 927 pregnant patients completed the questionnaire. Among them, 97.3% complained of at least one urinary disorder. Frequency was the symptom reported most often (77.3%), whereas nocturnal enuresis was the least reported (17%). Despite the high prevalence of LUTS in our sample, only 13.4% reported that they negatively impact their quality of life. Overweight and obesity, advanced maternal age, smoking, family history of pelvic floor disorders and poor pelvic floor contraction capacity were confirmed to be risk factors for the onset of LUTS, even in our population. CONCLUSIONS Urinary symptoms are extremely common in the third trimester and significantly affect the quality of life of pregnant women. Since overweight, obesity, smoking and reduced pelvic floor contractility emerged as modifiable risk factors for the development of these symptoms, prevention and adequate counselling are cornerstones of pregnancy care.
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Affiliation(s)
- Sara Bosio
- ASST Santi Paolo e Carlo, San Paolo Hospital, Via Antonio di Rudinì 8, 20142, Milan, MI, Italy
- University of Milano, Milan, Italy
| | - Matteo Frigerio
- ASST Monza, San Gerardo Hospital, Monza, Italy
- Urogynecology-Pelvic Floor Working Group (GLUP), Monza, MB, Italy
| | | | | | - Pasquale Gallo
- Urogynecology-Pelvic Floor Working Group (GLUP), Monza, MB, Italy
- San Giovanni di Dio Hospital, ASL Napoli 2 Nord, Frattamaggiore, Na, Italy
| | - Giulia Magoga
- ULSS2 Marca Trevigiana, Oderzo Hospital, Oderzo, Italy
| | - Stefano Manodoro
- ASST Santi Paolo e Carlo, San Paolo Hospital, Via Antonio di Rudinì 8, 20142, Milan, MI, Italy.
- University of Milano, Milan, Italy.
- Urogynecology-Pelvic Floor Working Group (GLUP), Monza, MB, Italy.
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Frigerio M, Barba M, Volontè S, Marino G, Melocchi T, De Vicari D, Cola A. Surgical management of rectovaginal fistula after stapled transanal rectal resection for prolapsed hemorrhoids. Int Urogynecol J 2023; 34:2325-2327. [PMID: 36811636 DOI: 10.1007/s00192-023-05490-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Rectovaginal fistula is an epithelium-lined direct communication route between the vagina and the rectum. The gold standard of fistula management is surgical treatment. Rectovaginal fistula after stapled transanal rectal resection (STARR) may be challenging to treat, due to the extensive scarring, the local ischemia, and the risk of rectal stenosis. We aimed to present a case of iatrogenic rectovaginal fistula after STARR that was successfully treated with a transvaginal primary layered repair and bowel diversion. METHODS A 38-year-old woman was referred to our division for continuous fecal discharge through her vagina that developed a few days after she had a STARR for prolapsed hemorrhoids. Clinical examination revealed a 2.5 cm-wide direct communication between the vagina and rectum. After proper counseling, the patient was admitted to transvaginal layered repair and temporary laparoscopic bowel diversion RESULTS: No surgical complications were observed. The patient was successfully discharged home on postoperative day 3. Bowel diversion was reversed after 2 months. At the current follow-up (6 months), the patient is asymptomatic and without recurrence. CONCLUSIONS The procedure was successful in obtaining anatomical repair and relieving symptoms. This approach represents a valid procedure for the surgical management of this severe condition.
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Affiliation(s)
- Matteo Frigerio
- Fondazione IRCCS San Gerardo dei Tintori, via G.B. Pergolesi, 33 20900, Monza, Italy
| | - Marta Barba
- Fondazione IRCCS San Gerardo dei Tintori, via G.B. Pergolesi, 33 20900, Monza, Italy.
- University of Milano-Bicocca, Monza, Italy.
| | | | | | | | | | - Alice Cola
- Fondazione IRCCS San Gerardo dei Tintori, via G.B. Pergolesi, 33 20900, Monza, Italy
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Barba M, Cola A, Passoni P, La Milia L, De Vicari D, Frigerio M. Transvaginal repair of isthmocele after cesarean scar pregnancy. Int J Gynaecol Obstet 2023; 162:775-776. [PMID: 37269103 DOI: 10.1002/ijgo.14900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/16/2023] [Indexed: 06/04/2023]
Abstract
SynopsisThe transvaginal approach represents a suitable choice for the management of isthmocele in women seeking to become pregnant.
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Affiliation(s)
- Marta Barba
- Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy
| | - Alice Cola
- Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy
| | - Paolo Passoni
- Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy
| | - Laura La Milia
- Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy
| | - Desirèe De Vicari
- Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy
| | - Matteo Frigerio
- Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy
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Barba M, Bernasconi DP, Manodoro S, Frigerio M. Response: Risk factors for obstetric anal sphincter injury recurrence: A systematic review and meta-analysis. Int J Gynaecol Obstet 2023; 162:779-780. [PMID: 37303097 DOI: 10.1002/ijgo.14940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Marta Barba
- Department of Obstetrics and Gynecology, University Milano-Bicocca, Monza, Italy
| | | | - Stefano Manodoro
- Department of Obstetrics and Gynecology, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Matteo Frigerio
- Department of Gynecology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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Frigerio M, Marino G, Barba M, Palmieri S, Ruffolo AF, Degliuomini R, Gallo P, Magoga G, Manodoro S, Vergani P. Prevalence and severity of bowel disorders in the third trimester of pregnancy. AJOG Glob Rep 2023; 3:100218. [PMID: 37645654 PMCID: PMC10461240 DOI: 10.1016/j.xagr.2023.100218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Bowel-related disorders are common conditions associated with pregnancy and are a cause of significant distress and healthcare burden. However, there is a lack of data in the literature about these disorders. OBJECTIVE This study aimed to investigate bowel dysfunctions during the third trimester of pregnancy in a large cohort of women using the validated bowel domain of the Italian version of the Pelvic Floor Questionnaire for Pregnant and Postpartum Women. STUDY DESIGN This was a secondary analysis of a multicenter cross-sectional study conducted in hospitals in Italy and Italian-speaking Switzerland. Women in the third trimester of pregnancy were asked to complete the Italian Pelvic Floor Questionnaire for Pregnant and Postpartum Women. RESULTS During the study period, 927 pregnant women in the third trimester of pregnancy responded to the questionnaire and were included in the analysis. Overall bowel dysfunctions were reported by 29.6% of patients. Constipation was reported by 66.6% of pregnant women, whereas symptoms of obstructed defecation were reported by 49.9% of patients. In contrast, urgency was reported by 41.1% of patients. Incontinence to flatus and incontinence to stool were reported by 45.1% and 2.8% of patients, respectively. Moreover, age >35 years, familiarity with pelvic floor disorders, nicotine abuse, and pelvic floor contraction inability were identified as independent risk factors for at least 1 bowel symptom. CONCLUSION Bowel symptoms are extremely common in the third trimester of pregnancy and can greatly affect a patient's quality of life; therefore, bowel symptoms deserve to be investigated and managed properly. The use of validated questionnaires represents a precious tool to investigate functional symptoms that could be very frequent and disabling in this particular period of life for women.
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Affiliation(s)
- Matteo Frigerio
- ASST Monza, San Gerardo Hospital, Monza, Italy (Dr Frigerio)
- Urogynecology-Pelvic Floor Working Group, Monza, Italy (Drs Frigerio, Gallo, and Manodoro)
| | - Giuseppe Marino
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, Milano, Italy (Drs Marino, Barba, and Palmieri)
| | - Marta Barba
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, Milano, Italy (Drs Marino, Barba, and Palmieri)
| | - Stefania Palmieri
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, Milano, Italy (Drs Marino, Barba, and Palmieri)
| | | | | | - Pasquale Gallo
- Urogynecology-Pelvic Floor Working Group, Monza, Italy (Drs Frigerio, Gallo, and Manodoro)
- San Giovanni di Dio Hospital, ASL Napoli 2 Nord, Frattamaggiore, Italy (Dr Gallo)
| | - Giulia Magoga
- ULSS2 Marca Trevigiana, Oderzo Hospital, Oderzo, Italy (Dr Magoga)
| | - Stefano Manodoro
- Urogynecology-Pelvic Floor Working Group, Monza, Italy (Drs Frigerio, Gallo, and Manodoro)
- ASST Santi Paolo e Carlo, San Paolo Hospital, Milano, Italy (Dr Manodoro)
| | - Patrizia Vergani
- Obstetric Division, Monza and Brianza Mother and Child Foundation, Monza, Italy (Dr Vergani)
| | - Urogynecology-Pelvic Floor Working Group
- ASST Monza, San Gerardo Hospital, Monza, Italy (Dr Frigerio)
- Urogynecology-Pelvic Floor Working Group, Monza, Italy (Drs Frigerio, Gallo, and Manodoro)
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, Milano, Italy (Drs Marino, Barba, and Palmieri)
- San Raffaele University, Milano, Italy (Drs Ruffolo and Degliuomini)
- San Giovanni di Dio Hospital, ASL Napoli 2 Nord, Frattamaggiore, Italy (Dr Gallo)
- ULSS2 Marca Trevigiana, Oderzo Hospital, Oderzo, Italy (Dr Magoga)
- ASST Santi Paolo e Carlo, San Paolo Hospital, Milano, Italy (Dr Manodoro)
- Obstetric Division, Monza and Brianza Mother and Child Foundation, Monza, Italy (Dr Vergani)
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Barba M, Cola A, Costa C, Liberatore A, Frigerio M. Efficacy and Adverse Effects After Single-Incision Slings for Women with Stress Urinary Incontinence: A 12-Year Follow-Up. Int J Womens Health 2023; 15:1077-1082. [PMID: 37483887 PMCID: PMC10362859 DOI: 10.2147/ijwh.s410539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023] Open
Abstract
Objective Single-incision slings (SISs) are not considered the first surgical choice for stress urinary incontinence due to few data about long-term results. Our aim was to evaluate the outcomes of SISs 12 years after implantation and to search for consequences such as deterioration after a certain amount of time. Methods We included women with stress urinary incontinence both clinically and urodynamically proven who underwent SISs procedure. Objective and subjective cure rates were compared to short-term outcomes to detect possible deterioration over time. Results A total of 85 patients were analysed with a median follow-up of 12.0 (IQR 10.4-12.8) years. Objective and subjective cure rates were 81.0% and 82.1%, respectively. Median (IQR) PGI-I scores and ICIQ-SF, respectively, were 1 (1-2) and 0 (0-6.8). No significant deterioration of outcomes over time was shown after comparison between short-term and long-term follow-ups (objective cure rate 84.5% vs 81.0%, p=0.684; subjective cure rates 92.9% vs 82.1%, p=0.060). Also, voiding symptoms and overactive bladder did not differ over time (20.2% vs 21.4%, p=1.000; 20.2% vs 33.3%, p=0.080, respectively). Conclusion SISs were shown to be a procedure with a great efficacy and safety profile at very long-term follow-up.
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Affiliation(s)
- Marta Barba
- Obstetric and Gynecology Department - University of Milano-Bicocca, Monza, Italy
| | - Alice Cola
- Gynecology Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Clarissa Costa
- Obstetric and Gynecology Department - University of Milano-Bicocca, Monza, Italy
| | | | - Matteo Frigerio
- Gynecology Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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Barba M, Cola A, Rezzan G, Frigerio M. Transvaginal excision of urethral diverticulum: A video case report. Eur J Obstet Gynecol Reprod Biol 2023; 286:154-156. [PMID: 37263833 DOI: 10.1016/j.ejogrb.2023.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 05/19/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Marta Barba
- Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy.
| | - Alice Cola
- Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giorgia Rezzan
- Fondazione IRCCS San Gerardo dei Tintori, Ospedale San Gerardo, Monza, Italy
| | - Matteo Frigerio
- Fondazione IRCCS San Gerardo dei Tintori, Ospedale San Gerardo, Monza, Italy
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Barba M, Cola A, Rezzan G, Costa C, Melocchi T, De Vicari D, Terzoni S, Frigerio M, Maruccia S. Flat Magnetic Stimulation for Stress Urinary Incontinence: A 3-Month Follow-Up Study. Healthcare (Basel) 2023; 11:1730. [PMID: 37372848 DOI: 10.3390/healthcare11121730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/05/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND flat magnetic stimulation is based on a stimulation produced by electromagnetic fields with a homogenous profile. Patients with stress urinary incontinence (SUI) can take advantage of this treatment. We aimed to evaluate medium-term subjective, objective, and quality-of-life outcomes in patients with stress urinary incontinence to evaluate possible maintenance schedules. METHODS a prospective evaluation through the administration of the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), the Incontinence Impact Questionnaire (IIQ7), and the Female Sexual Function Index (FSFI) was performed at three different time points: at the baseline (T0), at the end of treatment (T1), and at 3-month follow-up (T2). The stress test and the Patient Global Impression of Improvement questionnaire (PGI-I) defined objective and subjective outcomes, respectively. RESULTS 25 consecutive patients were enrolled. A statistically significant reduction in the IIQ7 and ICIQ-SF scores was noticed at T1 returned to levels comparable to the baseline at T2. However, objective improvement remained significant even at a 3-month follow-up. Moreover, the PGI-I scores at T1 and T2 were comparable, demonstrating stable subjective satisfaction. CONCLUSION despite a certain persistence of the objective and subjective continence improvement, the urinary-related quality of life decreases and returns to baseline values three months after the end of flat magnetic stimulation. These findings indicate that a further cycle of treatment is probably indicated after 3 months since benefits are only partially maintained after this timespan.
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Affiliation(s)
- Marta Barba
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Alice Cola
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Giorgia Rezzan
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Clarissa Costa
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Tomaso Melocchi
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Desirèe De Vicari
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Stefano Terzoni
- Department of Urology, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milano, Italy
| | - Matteo Frigerio
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Serena Maruccia
- Department of Urology, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milano, Italy
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Barba M, Morciano A, Melocchi T, Cola A, Inzoli A, Passoni P, Frigerio M. Superinfection of Rectovaginal Endometriosis: Case Report and Review of the Literature. Diagnostics (Basel) 2023; 13:diagnostics13091514. [PMID: 37174906 PMCID: PMC10177285 DOI: 10.3390/diagnostics13091514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/05/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND A peculiar complication of endometriosis is a superinfection. However, the superinfection of extra-ovarian endometriosis is anecdotal, and only a few cases have been described. We wanted to present the first cases of the superinfection of rectovaginal endometriosis and to perform a literature review of the superinfection of extra-ovarian endometriosis. METHODS We present a case of a 24-year-old woman who was referred to our Pelvic Floor Unit for rectal-perineal pain, dyspareunia, and recurrent episodes of dense purulent vaginal discharge for one year, in which the superinfection of rectovaginal endometriosis was diagnosed. Moreover, we performed a systematic search of the literature indexed on PubMed up to 31 January 2023. RESULTS Laparoscopic drainage was successful in managing this condition. In the literature, clinical presentation and instrumental and microbiological findings are very heterogeneous. However, the gold standard of management is represented by surgical or percutaneous drainage. CONCLUSIONS In the case of a pelvic abscess, the superinfection of endometriosis lesions should be suspected, and this can represent the onset symptom of endometriosis. Ultrasonography may show nodular or flat hypoechoic lesions with hyperechoic debris and peripheral positive color/power Doppler intensities. The goal of management is to drain the abscess, either percutaneously or via traditional surgery, followed by proper hormonal therapy to reduce recurrence.
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Affiliation(s)
- Marta Barba
- Department of Gynecology and Obstetrics, Pelvic Floor Center, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Andrea Morciano
- Department of Gynecology and Obstetrics, Panico Pelvic Floor Center, Pia Fondazione "Cardinale G. Panico", 73039 Tricase, Italy
| | - Tomaso Melocchi
- Department of Gynecology and Obstetrics, Pelvic Floor Center, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Alice Cola
- Department of Gynecology and Obstetrics, Pelvic Floor Center, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Alessandra Inzoli
- Department of Gynecology and Obstetrics, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Paolo Passoni
- Department of Gynecology and Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, ASST Monza, Ospedale San Gerardo, 20900 Monza, Italy
| | - Matteo Frigerio
- Department of Gynecology and Obstetrics, Pelvic Floor Center, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
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Baruch Y, Manodoro S, Barba M, Cola A, Re I, Frigerio M. Prevalence and Severity of Pelvic Floor Disorders during Pregnancy: Does the Trimester Make a Difference? Healthcare (Basel) 2023; 11:healthcare11081096. [PMID: 37107930 PMCID: PMC10137441 DOI: 10.3390/healthcare11081096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
(1) Background: Women experience pelvic floor dysfunction symptoms during pregnancy. This study is the first to investigate and compare variances in the prevalence and severity of pelvic floor symptoms between trimesters using a valid pregnancy-targeted questionnaire. (2) Methods: A retrospective cohort study was conducted between August 2020 to January 2021 at two university-affiliated tertiary medical centers. Pregnant women (n = 306) anonymously completed the Pelvic Floor Questionnaire for Pregnancy and Postpartum with its four domains (bladder, bowel, prolapse, and sexual). (3) Results: Thirty-six women (11.7%) were in the 1st trimester, eighty-three (27.1%) were in the 2nd trimester, and one hundred and eighty-seven (61.1%) were in the 3rd trimester. The groups were similar in age, pregestational weight, and smoking habits. A total of 104 (34%) had bladder dysfunction, 112 (36.3%) had bowel dysfunction, and 132 (40.4%) reported sexual inactivity and/or sexual dysfunction. Least prevalent (33/306; 10.8%) were prolapse symptoms. Increased awareness of prolapse and significantly higher rates of nocturia and the need to use pads due to incontinence were recorded in the 3rd trimester. Sexual dysfunction or abstinence were equally distributed in all three trimesters. (4) Conclusions: Bladder and prolapse symptoms, equally frequent throughout pregnancy, significantly intensified in the 3rd trimester. Bowel and sexual symptoms, equally frequent throughout pregnancy, did not intensify in the third trimester.
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Affiliation(s)
- Yoav Baruch
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Stefano Manodoro
- Department of Obstetrics and Gynecology, ASST Santi Paolo e Carlo, San Paolo Hospital, 20132 Milano, Italy
| | - Marta Barba
- Department of Obstetrics and Gynecology, Fondazione IRCCS San Gerardo dei Tintori, University Milano Bicocca, 20900 Monza, Italy
| | - Alice Cola
- Department of Obstetrics and Gynecology, Fondazione IRCCS San Gerardo dei Tintori, University Milano Bicocca, 20900 Monza, Italy
| | - Ilaria Re
- Department of Obstetrics and Gynecology, Fondazione IRCCS San Gerardo dei Tintori, University Milano Bicocca, 20900 Monza, Italy
| | - Matteo Frigerio
- Department of Obstetrics and Gynecology, Fondazione IRCCS San Gerardo dei Tintori, University Milano Bicocca, 20900 Monza, Italy
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Frigerio M, Barba M, Cola A, Marino G, Volontè S, Melocchi T, De Vicari D, Passoni P. Pelvic pain after laparoscopic lateral suspension for pelvic organ prolapse: an unrecognized problem? Int Urogynecol J 2023; 34:951-955. [PMID: 36205726 DOI: 10.1007/s00192-022-05374-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/02/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The laparoscopic lateral suspension (LLS) represents an alternative mesh procedure to avoid the dissection at the promontory. However, mesh-related complications such as chronic pelvic pain, dyspareunia, and bladder pain are emerging. The present study is aimed to present a video case report and describe a small case series of patients referred to our center for chronic pelvic pain after LLS. METHODS A surgical video of the management of a 50-year-old woman with chronic abdominal and pelvic pain, dyspareunia, and recurrent urinary tract infection (UTIs) after uterus sparing LLS is provided. Moreover, we performed a retrospective chart review of similar cases in our institution. RESULTS The featured procedure was completed without complications and was successful in obtaining symptom relief. Between 2018 and 2022 five patients underwent total or subtotal mesh removal for pain-related symptoms after LLS. At the median follow-up of 24 months, all patients were free from pain, but two (40%) required reoperation for prolapse recurrence CONCLUSIONS: Our experience suggests that LLS involves a certain risk of chronic pelvic pain, which may be challenging to manage and require surgical treatment.
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Affiliation(s)
- Matteo Frigerio
- Ospedale San Gerardo, via G.B. Pergolesi, 33 20900, Monza, Italy
| | - Marta Barba
- Ospedale San Gerardo, via G.B. Pergolesi, 33 20900, Monza, Italy.
- University of Milano-Bicocca, Monza, Italy.
| | - Alice Cola
- Ospedale San Gerardo, via G.B. Pergolesi, 33 20900, Monza, Italy
| | | | | | | | | | - Paolo Passoni
- Ospedale San Gerardo, via G.B. Pergolesi, 33 20900, Monza, Italy
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Marino G, Alfieri N, Tessitore IV, Barba M, Manodoro S, Frigerio M. Hematocolpos due to imperforate hymen: a case report and literature systematic review. Int Urogynecol J 2023; 34:357-369. [PMID: 35713674 DOI: 10.1007/s00192-022-05270-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/03/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Hematocolpos is a rare condition, where menstrual blood fills the vagina, instead of being expelled, due to a series of uterovaginal pathologies, the most frequent of which is the imperforate hymen. To date, few cases of hematocolpos have been reported in the literature. METHODS We report a case of hematometrocolpos due to imperforate hymen initially misdiagnosed as constipation and subsequently as ovarian mass; moreover, the present study undertakes a systematic review of studies on hematometrocolpos due to imperforate hymen to synthesize available knowledge on epidemiology, diagnosis, and management about this rare condition. RESULTS A total of 35 studies, describing 61 patients, were identified. The presence of hematocolpos should be suspected in premenarchal patients complaining of low abdominal pain, abdominal swelling, and urinary retention. Genital examination disclosing a tender, pale hymen and ultrasound represent a useful tool for diagnosis. The goal of the management is to timely perform hymenotomy to drain the hematocolpos, followed by hymenectomy to prevent recurrence. Follow-up is needed to diagnose possible recurrences. CONCLUSIONS In the case of an adolescent girl complaining of genital pain associated with primary amenorrhea, hematocolpos due to imperforate hymen should be suspected.
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Affiliation(s)
- G Marino
- University of Milano-Bicocca, Monza, Italy
| | | | | | - M Barba
- University of Milano-Bicocca, Monza, Italy
| | - S Manodoro
- ASST Santi Paolo e Carlo, San Paolo University Hospital, Milano, Italy
| | - Matteo Frigerio
- ASST Monza, San Gerardo University Hospital, via G.B. Pergolesi, 33, Monza, IT, Italy.
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Braga A, Barba M, Serati M, Soligo M, Li Marzi V, Finazzi Agrò E, Musco S, Caccia G, Castronovo F, Manodoro S, Frigerio M. Update on Italian-validated questionnaires for pelvic floor disorders. Minerva Obstet Gynecol 2023; 75:62-68. [PMID: 34328299 DOI: 10.23736/s2724-606x.21.04901-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Pelvic floor disorders (PFDs), which include urinary incontinence, pelvic organ prolapse, sexual dysfunction and gastrointestinal disorders, affect over 20% of the adult population. Prevalence may also be underestimated, since a certain portion of patients may be reluctant to talk to physicians about PFDs due to embarrassment. Consequently, there is a need for self-assessed diagnostic tools with the capability to screen population and collect clinical information. Symptom and quality of life (QoL) questionnaires - also identified as patient-reported outcomes (PROs) - have been developed with this purpose. Despite the large number of questionnaires available for the assessment of PFDs and QoL-related issues in the English language, few of them have been validated for the Italian language. The objective of this article is to update the list of Italian-validated PROs for PFDs along with practical information concerning literature references and suggestions on how to obtain every single questionnaire. EVIDENCE ACQUISITION PubMed/MEDLINE databases and websites were used to update the list of available Italian-validated questionnaires about PFDs. Once identified, the possibility to get a copy of the questionnaire was verified and steps to obtain it are reported in the tables. EVIDENCE SYNTHESIS Eight additional questionnaires validated into the Italian language, for diagnosis and overall management of common urinary, vaginal, sexual and bowel conditions, were retrieved. The complete list of PFDs PROS is reported in a modular format for consultation. CONCLUSIONS This format is intended to serve as a tool to promote appropriateness in PROs adoption while investigating PFDs in Italian patients.
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Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Switzerland - .,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Mendrisio, Switzerland -
| | - Marta Barba
- Department of Obstetrics and Gynecology, San Gerardo Hospital, Milano Bicocca University, Monza, Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Marco Soligo
- Department of Obstetrics and Gynecology, Buzzi Hospital, Milan, Italy
| | - Vincenzo Li Marzi
- Department of Urology, AOU Careggi Hospital, University of Florence, Florence, Italy
| | - Enrico Finazzi Agrò
- Unit of Urology, Department of Surgical Sciences, Tor Vergata University Hospital, Rome, Italy
| | - Stefania Musco
- Department of Urology, Careggi Hospital, Florence, Italy
| | - Giorgio Caccia
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Switzerland
| | - Fabiana Castronovo
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Switzerland
| | - Stefano Manodoro
- Department of Obstetrics and Gynecology, San Paolo Hospital, Milan, Italy
| | - Matteo Frigerio
- Department of Obstetrics and Gynecology, San Gerardo Hospital, Milano Bicocca University, Monza, Italy
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Peng L, Matellan C, Bosch-Fortea M, Gonzalez-Molina J, Frigerio M, Salentinig S, Del Rio Hernandez A, Gautrot JE. Mesenchymal Stem Cells Sense the Toughness of Nanomaterials and Interfaces. Adv Healthc Mater 2023; 12:e2203297. [PMID: 36717365 DOI: 10.1002/adhm.202203297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/20/2023] [Indexed: 02/01/2023]
Abstract
Stem cells are known to sense and respond to the mechanical properties of biomaterials. In turn, cells exert forces on their environment that can lead to striking changes in shape, size and contraction of associated tissues, and may result in mechanical disruption and functional failure. However, no study has so far correlated stem cell phenotype and biomaterials toughness. Indeed, disentangling toughness-mediated cell response from other mechanosensing processes has remained elusive as it is particularly challenging to uncouple Youngs' or shear moduli from toughness, within a range relevant to cell-generated forces. In this report, it is shown how the design of the macromolecular architecture of polymer nanosheets regulates interfacial toughness, independently of interfacial shear storage modulus, and how this controls the expansion of mesenchymal stem cells at liquid interfaces. The viscoelasticity and toughness of poly(l-lysine) nanosheets assembled at liquid-liquid interfaces is characterised via interfacial shear rheology. The local (microscale) mechanics of nanosheets are characterised via magnetic tweezer-assisted interfacial microrheology and the thickness of these assemblies is determined from in situ ellipsometry. Finally, the response of mesenchymal stem cells to adhesion and culture at corresponding interfaces is investigated via immunostaining and confocal microscopy.
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Affiliation(s)
- Lihui Peng
- Institute of Bioengineering, Queen Mary University of London, Mile End Road, E1 4NS, London, UK.,Cellular and Molecular Biomechanical Laboratory, Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK
| | - Carlos Matellan
- School of Engineering and Materials Science, Queen Mary, University of London, Mile End Road, London, E1 4NS, UK
| | - Minerva Bosch-Fortea
- Institute of Bioengineering, Queen Mary University of London, Mile End Road, E1 4NS, London, UK.,Cellular and Molecular Biomechanical Laboratory, Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK
| | - Jordi Gonzalez-Molina
- Institute of Bioengineering, Queen Mary University of London, Mile End Road, E1 4NS, London, UK.,Cellular and Molecular Biomechanical Laboratory, Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK
| | - Matteo Frigerio
- Department of Chemistry, University of Fribourg, Chemin du Musée 9, Fribourg, 1700, Switzerland
| | - Stefan Salentinig
- Department of Chemistry, University of Fribourg, Chemin du Musée 9, Fribourg, 1700, Switzerland
| | - Armando Del Rio Hernandez
- School of Engineering and Materials Science, Queen Mary, University of London, Mile End Road, London, E1 4NS, UK
| | - Julien E Gautrot
- Institute of Bioengineering, Queen Mary University of London, Mile End Road, E1 4NS, London, UK.,Cellular and Molecular Biomechanical Laboratory, Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK
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Torella M, Marrapodi MM, Ronsini C, Ruffolo AF, Braga A, Frigerio M, Amabile E, Vastarella MG, Rossi F, Riemma G. Risk of Premature Ovarian Insufficiency after Human Papilloma Virus Vaccination: A PRISMA Systematic Review and Meta-Analysis of Current Evidence. Vaccines (Basel) 2023; 11:vaccines11010140. [PMID: 36679985 PMCID: PMC9866915 DOI: 10.3390/vaccines11010140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
(1) Background: Premature ovarian insufficiency (POI) has been linked to human papilloma virus (HPV) vaccination in small case-reports. The aim of this meta-analysis was to evaluate the risk of POI after HPV vaccination. (2) Methods: Electronic searches in MEDLINE Scopus, LILACS, ClinicalTrials.gov, EMBASE, PROSPERO, Cochrane CENTRAL and other registries were searched from inception to September 2022. Inclusion criteria were cohort studies of female children or adolescents vaccinated with quadrivalent (4vHPV), bivalent (2vHPV) or 9-valent (9vHPV) vaccine and compared to unvaccinated, other HPV vaccine, or vaccinated with other childhood vaccine girls. Primary outcome was risk of POI after vaccination. (3) Results: Four studies, including 1,253,758 patients, were included. Overall, there was no significant risk for POI between 4vHPV and controls (unvaccinated or other vaccines) (RR 0.47 (95% CI 0.14 to 1.59) I2 = 75%), or unvaccinated only controls (RR 0.75 (95% CI 0.22 to 2.49) I2 = 26%). One study reported a significant reduction of POI risk for 4vHPV relative to the other childhood vaccinations (RR 0.03 (95% CI 0.00 to 0.21)); meanwhile, one study showed no increased risk with 4vHPV relative to 2vHPV and 9vHPV (RR 0.93 (95% CI 0.33 to 2.64)). (4) Conclusions: 4vHPV vaccination does not seem to increase risk of POI relative to unvaccinated people or other childhood vaccines. No difference was seen with 4vHPV vaccine relative to 2vHPV and 9vHPV. Moreover, the risk of POI after HPV vaccination is relatable to worldwide incidence, giving reassurance about safety.
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Affiliation(s)
- Marco Torella
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy
- Correspondence:
| | - Maria Maddalena Marrapodi
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy
| | - Carlo Ronsini
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy
| | | | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC, Beata Vergine Hospital, 6850 Mendrisio, Switzerland
| | | | - Emanuele Amabile
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy
| | - Maria Giovanna Vastarella
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy
| | - Francesca Rossi
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy
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Frigerio M, Barba M, Cola A, Spelzini F, Milani R, Manodoro S. Coexisting overactive-underactive bladder and detrusor overactivity-underactivity in pelvic organ prolapse. Int J Gynaecol Obstet 2023; 160:256-262. [PMID: 35617299 PMCID: PMC10083922 DOI: 10.1002/ijgo.14288] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 03/19/2022] [Accepted: 05/24/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The coexisting overactive-underactive bladder (COUB) syndrome could be related to the increased urethral resistance caused by severe pelvic organ prolapse (POP). We aimed to evaluate the clinical and urodynamic findings of patients with COUB and/or detrusor overactivity-underactivity (DOU) in a cohort of patients scheduled for POP surgery and the possible risk factors of COUB after surgery. METHODS This retrospective study analyzed all patients who underwent POP repair between 2008 and 2013, excluding women with a history of pelvic floor surgery. Patients were divided into COUB and non-COUB according to baseline symptoms and into DOU and non-DOU based on urodynamic findings. A multivariate model was performed to identify risk factors for COUB symptoms after surgery. RESULTS A total of 533 women underwent POP surgery. Preoperatively, patients with COUB had more severe anterior compartment prolapse (Pelvic Organ Prolapse Quantification staging system Aa point, P = 0.008) and more frequently had overactive bladder compared with controls (P = 0.023). The rate of COUB decreased significantly after surgery. Preoperative opening detrusor pressure resulted as the only independent predictor of postoperative COUB symptoms (P = 0.034). CONCLUSION POP is a valid pathogenetic model for COUB development. POP repair induced a significant decrease in COUB symptoms with low opening detrusor pressure resulting as the only independent predictor of postoperative COUB.
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Affiliation(s)
- Matteo Frigerio
- Department of Obstetrics and Gynecology, ASST Monza, Ospedale San Gerardo, Monza, Italy.,Department of Obstetrics and Gynecology, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Marta Barba
- Department of Obstetrics and Gynecology, ASST Monza, Ospedale San Gerardo, Monza, Italy.,Department of Obstetrics and Gynecology, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Alice Cola
- Department of Obstetrics and Gynecology, ASST Monza, Ospedale San Gerardo, Monza, Italy.,Department of Obstetrics and Gynecology, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Federico Spelzini
- Department of Obstetrics and Gynecology, AUSL Romagna, Ospedale Infermi, Rimini, Italy
| | - Rodolfo Milani
- Department of Obstetrics and Gynecology, ASST Monza, Ospedale San Gerardo, Monza, Italy
| | - Stefano Manodoro
- Department of Obstetrics and Gynecology, ASST Santi Paolo e Carlo, Ospedale San Paolo, Milan, Italy
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35
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Barba M, Frigerio M, Melocchi T, De Vicari D, Cola A. Urethral Injury After Vaginal Birth and Stress Urinary Incontinence: Bulking Agents are Feasible Options. Int J Womens Health 2023; 15:725-729. [PMID: 37193222 PMCID: PMC10183179 DOI: 10.2147/ijwh.s405636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023] Open
Abstract
Introduction and Hypothesis Lower urinary tract tears after vaginal delivery are a very rare event, estimated to occur in 0.03-0.05% of women and may be associated with severe stress urinary incontinence, due to great reduction of urethral resistance resulting in a significant intrinsic urethral deficit. Urethral bulking agents represent an alternative, minimally invasive anti-incontinence procedure in the management of stress urinary incontinence. Our aim is to present the management of severe stress urinary incontinence in a patient with concomitant urethral tear caused by obstetric trauma using a minimally invasive treatment option. Methods A 39-year-old woman referred to our Pelvic Floor Unit for severe stress urinary incontinence. Our evaluation demonstrated an undiagnosed urethral tear involving the ventral portion of the middle and distal urethra, for about 50% of urethral length. Urodynamic evaluation confirmed the presence of severe urodynamic stress incontinence. After proper counseling, she was admitted to mini-invasive surgical treatment with urethral bulking agent injection. Results The procedure was completed in 10 minutes and she was successfully discharged home on the same day, and no complications occurred. The treatment resulted in total relief of urinary symptoms, which persists at 6-month follow-up. Conclusion Treatment with urethral bulking agent injection represents a feasible mini-invasive option to manage stress urinary incontinence related to urethral tears.
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Affiliation(s)
- Marta Barba
- Gynecology and Obstetric Department, University of Milano-Bicocca, Monza, Italy
- Correspondence: Marta Barba, University of Milano-Bicocca, ASST Monza, Ospedale San Gerardo, via G.B. Pergolesi, 33, Monza, 20900, Italy, Tel +39 2339434, Email
| | - Matteo Frigerio
- Gynecology and Obstetric Department, Fondazione IRCCS San Gerardo Dei Tintori, Ospedale San Gerardo, Monza, Italy
| | - Tomaso Melocchi
- Gynecology and Obstetric Department, University of Milano-Bicocca, Monza, Italy
| | - Desirèe De Vicari
- Gynecology and Obstetric Department, University of Milano-Bicocca, Monza, Italy
| | - Alice Cola
- Gynecology and Obstetric Department, Fondazione IRCCS San Gerardo Dei Tintori, Ospedale San Gerardo, Monza, Italy
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36
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Frigerio M, Barba M, Marino G, Volontè S, Melocchi T, De Vicari D, Torella M, Salvatore S, Braga A, Serati M, Manodoro S, Cola A. Coexistent Detrusor Overactivity-Underactivity in Patients with Pelvic Floor Disorders. Healthcare (Basel) 2022; 10:healthcare10091720. [PMID: 36141332 PMCID: PMC9498318 DOI: 10.3390/healthcare10091720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction and Hypothesis: Pelvic floor disorders represent a series of conditions that share, in part, the same etiological mechanisms, so they tend to be concomitant. Recently, awareness of a new lower urinary tract clinical syndrome has risen, namely the coexisting overactive–underactive bladder (COUB). The etiopathogenetic process, prevalence, and related instrumental findings of COUB are not well-established. We aimed to evaluate the prevalence, clinical features, and urodynamic findings of patients with COUB in a large cohort of patients with pelvic floor disorders. Methods: A cohort of 2092 women was retrospectively analyzed. A clinical interview, urogenital examination, and urodynamic assessment were performed by a trained urogynecologist. Based on baseline symptoms, patients were divided into COUB and non-COUB groups, and the degree of concordance between COUB and urodynamic findings, and other parameters related to the clinical aspects of these patients were measured and analyzed. Results: 18.8% of patients were classified as COUB. The association between COUB and patients with coexisting detrusor overactivity–underactivity (DOU) was statistically significant and there were substantial similarities in terms of population characteristics, symptoms, and urodynamic findings. Conclusions: Our study showed a high prevalence of COUB, and a link between this clinical syndrome and DOU was demonstrated. They showed substantial similarities in terms of clinical and urodynamics correlates. Based on these findings, we do think that urodynamic tests can be useful to improve knowledge on COUB and may be of help in the management of this condition.
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Affiliation(s)
- Matteo Frigerio
- San Gerardo Hospital, ASST Monza, 20900 Monza, Italy
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
- Correspondence: ; Tel.: +39-2339434; Fax: +39-2339433
| | - Marta Barba
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
| | - Giuseppe Marino
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
| | - Silvia Volontè
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
| | - Tomaso Melocchi
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
| | - Desirèe De Vicari
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
| | - Marco Torella
- Department of Woman, Luigi Vanvitelli University of Campania, 80138 Naples, Italy
| | - Stefano Salvatore
- Obstetrics and Gynaecology Department, Vita-Salute University and IRCCS San Raffaele Hospital, 20133 Milan, Italy
| | - Andrea Braga
- EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland
| | - Maurizio Serati
- Del Ponte Hospital, University of Insubria, 21100 Varese, Italy
| | - Stefano Manodoro
- ASST Santi Paolo e Carlo, San Paolo Hospital, 20132 Milano, Italy
| | - Alice Cola
- San Gerardo Hospital, ASST Monza, 20900 Monza, Italy
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
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Mandruzzato M, Cortinovis D, Fassi E, Ammoni L, Zamparini M, Colonese F, Bianchi S, Baggi A, Berruti A, Grisanti S, Frigerio M. EP08.02-172 Effect of EGFR Inhibition on Bone Health in NSCLC Patients without Skeletal Metastasis. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Mosca L, Riemma G, Braga A, Frigerio M, Ruffolo AF, Dominoni M, Munno GM, Uccella S, Serati M, Raffone A, Salvatore S, Torella M. Female Sexual Dysfunctions and Urogynecological Complaints: A Narrative Review. Medicina (B Aires) 2022; 58:medicina58080981. [PMID: 35893096 PMCID: PMC9331312 DOI: 10.3390/medicina58080981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/05/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
Female sexual dysfunctions represent a real widespread problem, usually faced from a psychological point of view; however, millions of women worldwide are impacted by pelvic floor dysfunction, personal shame and social taboos, however, continue to inhibit free conversation on the subject. Women’s quality of life is considerably improved by screening, diagnosing, and controlling urogenital and sexual issues. This review aims to provide a critical perspective of urogenital conditions and common disturbances in female sexual function associated with these issues. It also includes a discussion of postpartum pelvic dysfunction.
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Affiliation(s)
- Lavinia Mosca
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy; (L.M.); (G.R.); (G.M.M.)
| | - Gaetano Riemma
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy; (L.M.); (G.R.); (G.M.M.)
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland;
| | - Matteo Frigerio
- Department of Obstetrics and Gynecology, ASST Monza, Ospedale San Gerardo, 20900 Monza, Italy;
| | - Alessandro Ferdinando Ruffolo
- Obstetrics and Gynecology Unit, Vita-Salute University and IRCCS San Raffaele Hospital, 20132 Milan, Italy; (A.F.R.); (S.S.)
| | - Mattia Dominoni
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Gaetano Maria Munno
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy; (L.M.); (G.R.); (G.M.M.)
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, 37100 Verona, Italy;
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy;
| | - Antonio Raffone
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy;
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80100 Naples, Italy
| | - Stefano Salvatore
- Obstetrics and Gynecology Unit, Vita-Salute University and IRCCS San Raffaele Hospital, 20132 Milan, Italy; (A.F.R.); (S.S.)
| | - Marco Torella
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy; (L.M.); (G.R.); (G.M.M.)
- Correspondence:
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Barba M, Bernasconi DP, Manodoro S, Frigerio M. Risk factors for obstetric anal sphincter injury recurrence: A systematic review and meta-analysis. Int J Gynaecol Obstet 2022; 158:27-34. [PMID: 34559892 PMCID: PMC9298380 DOI: 10.1002/ijgo.13950] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/13/2021] [Accepted: 09/23/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Women with previous obstetric anal sphincter injuries (OASIs) are at a higher risk of recurrence in the subsequent pregnancy, which may lead to the development or worsening of anal incontinence. Due to a lack of evidence, few recommendations can be made about the factors that may affect the risk of OASI recurrence. OBJECTIVE We sought to conduct a systematic review and meta-analysis to investigate potential risk factors for recurrent OASIs. SEARCH STRATEGY Studies up to May 2019 were identified from PubMed, Scopus, Cochrane Library, and ISI Web of Science. SELECTION CRITERIA Studies assessing the impact of risk factors on OASI recurrence in subsequent pregnancies were included. Reviews, letters to the editor, conference abstracts, book chapters, guidelines, Cochrane reviews, and expert opinions were excluded. DATA COLLECTION AND ANALYSIS Data were extracted by two independent reviewers. Odds ratio and standardized mean difference were chosen as effect measures. Pooled estimates were calculated using the random-effects model. MAIN RESULTS The meta-analysis showed that maternal age, gestational age, occiput posterior presentation, oxytocin augmentation, operative delivery, and shoulder dystocia were associated with the risk of recurrent OASIs in the subsequent delivery. CONCLUSION Prenatal and intrapartum risk factors are associated with recurrence of OASI. PROSPERO registration no. CRD42020178125.
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Affiliation(s)
- Marta Barba
- Department of Obstetrics and GynecologyUniversity Milano‐BicoccaMonzaItaly
| | | | - Stefano Manodoro
- Department of Obstetrics and GynecologyASST Santi Paolo e Carlo, San Paolo HospitalMilanoItaly
| | - Matteo Frigerio
- Department of Obstetrics and GynecologyASST Monza, San Gerardo HospitalMonzaItaly
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Serati M, Braga A, Salvatore S, Torella M, Di Dedda MC, Scancarello C, Cimmino C, De Rosa A, Frigerio M, Candiani M, Ruffolo AF. Up-to-Date Procedures in Female Stress Urinary Incontinence Surgery: A Concise Review on Bulking Agents Procedures. Medicina (Kaunas) 2022; 58:medicina58060775. [PMID: 35744038 PMCID: PMC9227870 DOI: 10.3390/medicina58060775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022]
Abstract
To avoid complications related to mid-urethral slings (MUS), alternative procedures to treat stress urinary incontinence (SUI), such as urethral bulking agents (UBAs) have been adopted. The aim of this review is to narratively report the efficacy and safety of UBAs for SUI treatment. For this review, research from PubMed and EMBASE was performed to evaluate relevant studies that were undertaken from January 2012 to January 2022. Nineteen prospective studies were included. Several definitions of subjective and objective success were adopted. At a follow-up of <24 months, significant improvement was widely observed, even if with a heterogeneous rate of success between 32.7−90%, and a reinjection rate of 8.3−77.3%. Compared with other procedures, MUS resulted as significantly superior to UBAs but was balanced by a higher complication rate. Acute urinary retention, urinary tract infection and de novo urgency, and other complications, such as injection site rupture, urethral erosion and particle migration have been described after UBAs. SUI after UBAs treatment resulted in improvements in all studies and can be considered a safe and effective option to treat SUI. However, homogenous and longer-term data lack, limiting general recommendations. Thus, larger RCTs evaluating long-term effects are required.
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Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.S.); (C.C.); (A.D.R.)
- Correspondence: ; Tel.: +39-0332-299-309
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC—Beata Vergine Hospital, 6850 Mendrisio, Switzerland;
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Stefano Salvatore
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milano, Italy; (S.S.); (M.C.); (A.F.R.)
| | - Marco Torella
- Department of Obstetrics and Gynecology, Second Faculty, 80129 Naples, Italy;
| | - Maria Carmela Di Dedda
- Department of Obstetrics and Gynecology, ASST FBF-SACCO Macedonio Melloni Hospital, 20129 Milano, Italy;
| | - Chiara Scancarello
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.S.); (C.C.); (A.D.R.)
| | - Chiara Cimmino
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.S.); (C.C.); (A.D.R.)
| | - Andrea De Rosa
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.S.); (C.C.); (A.D.R.)
| | | | - Massimo Candiani
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milano, Italy; (S.S.); (M.C.); (A.F.R.)
| | - Alessandro Ferdinando Ruffolo
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milano, Italy; (S.S.); (M.C.); (A.F.R.)
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Volonte' S, Barba M, Cola A, Marino G, Frigerio M. Italian validation of the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Int Urogynecol J 2022; 33:3171-3175. [PMID: 35648181 PMCID: PMC9569287 DOI: 10.1007/s00192-022-05235-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 05/10/2022] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to translate the English short form of Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and evaluate its validity, internal consistency, and test-retest reliability. METHODS The questionnaire was translated into Italian by standardized procedural steps, and the final version was submitted to women referred to urogynecological outpatient care for genital prolapse or urinary incontinence reporting sexual disorders (cases) or not (controls). For the test-retest evaluation, cases received the questionnaire 2 weeks later. The Wilcoxon test (non-parametric) was used to assess differences between cases and controls. Convergent validity was tested with the Italian version of the FSFI-19. The internal consistency was tested using Cronbach's alpha. The degree of concordance/agreement was measured with Cohen's kappa. The absolute agreement of test-retest results was tested with the intraclass correlation coefficient (ICC). RESULTS Sixty women were recruited for the study and answered the questionnaire. The overall rate of missing items was 1.3%. Construct validity was demonstrated, as the questionnaire discriminated significantly between patients with and without symptoms. Convergent validity with FSFI-19 was tested, and a linear correlation between scores was demonstrated (F < 0.001). Internal consistency reliability evaluated with Cronbach's alpha was satisfactory (0.54-0.81). Cohen's kappa values as absolute agreement coefficients were between 0.59 and 0.80 (good agreement). Intraclass correlation coefficients ranged between 0.88 and 0.94 (very satisfactory agreement) for each functional domain. CONCLUSIONS The Italian version of the PISQ-12 is reliable, valid, and consistent.
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Affiliation(s)
- Silvia Volonte'
- ASST Monza, Ospedale San Gerardo, Via Pergolesi 33, Monza, Italy.
| | - Marta Barba
- ASST Monza, Ospedale San Gerardo, Via Pergolesi 33, Monza, Italy
| | - Alice Cola
- ASST Monza, Ospedale San Gerardo, Via Pergolesi 33, Monza, Italy
| | - Giuseppe Marino
- ASST Monza, Ospedale San Gerardo, Via Pergolesi 33, Monza, Italy
| | - Matteo Frigerio
- ASST Monza, Ospedale San Gerardo, Via Pergolesi 33, Monza, Italy
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Gentile P, Cantone R, Perna E, Ammirati E, Varrenti M, D‘Angelo L, Verde A, Foti G, Masciocco G, Garascia A, Frigerio M, Cipriani M. P217 SACUBITRIL/VALSARTAN IN ADVANCED HEART FAILURE: SAFETY AND EFFECTS ON HAEMODYNAMIC PARAMETERS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
The angiotensin–II receptor neprilysin inhibitor (ARNI), sacubitril/valsartan has been shown to be effective in treatment of patients with heart failure (HF), but limited data is available in patients with advanced disease. This retrospective observational study assessed the effects of ARNI treatment in patients with advanced HF.
Methods
We reviewed medical records of all advanced HF patients evaluated at our center for unconventional therapies from September 2016 to January 2019. We studied 44 patients who started ARNI therapy and who had a hemodynamic assessment before beginning ARNI and after 6 ± 2 months. The primary endpoint was variation in pulmonary pressures and filling pressures at 6 months after starting ARNI therapy.
Results
Mean patient age was 51.6±7.4 years; 84% were male. At 6±2 months after starting ARNI, there was significant reduction of systolic pulmonary artery pressure (PAP) (32 mmHg, IQR 27–45 vs 25 mmHg, IQR 22.3–36.5; p < 0.0001) and median PAP (20 mmHg, IQR 15.3–29.8 vs 17 mmHg, IQR 13–24.8; p = 0.046). Five of 22 patients (23%) were deferred from the heart transplant (HTx) list because of improvement, while four were listed de novo. After 23 ± 9 months, 3 patients were treated with a left ventricular assist device (LVAD) implantation, while 6 patients underwent Heart transplantation (one in emergency conditions for refractory ventricular tachycardia).
Conclusions
Sacubitril/valsartan is effective in reducing filling pressures and pulmonary pressures in patients with advanced HF. The absence of adverse events during follow–up suggests that sacubitril/valsartan is safe and well–tolerated in this cohort of patients.
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Affiliation(s)
- P Gentile
- DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO
| | - R Cantone
- DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO
| | - E Perna
- DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO
| | - E Ammirati
- DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO
| | - M Varrenti
- DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO
| | - L D‘Angelo
- DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO
| | - A Verde
- DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO
| | - G Foti
- DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO
| | - G Masciocco
- DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO
| | - A Garascia
- DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO
| | - M Frigerio
- DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO
| | - M Cipriani
- DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO
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Gentile P, Merlo M, Peretto G, Ammirati E, Sala S, Della Bella P, Aquaro G, Imazio M, Potena L, Campodonico J, Foà A, Raafs A, Hazebroek M, Brambatti M, Cercek A, Nucifora G, Shrivastava S, Huang F, Schmidt M, Muser D, Van De Heyning C, Van Craenenbroeck E, Aoki T, Sugimura K, Shimokawa H, Cannatà A, Artico J, Porcari A, Colopi M, Bussani R, Barbati G, Garascia A, Cipriani M, Agostoni P, Pereira N, Heymans S, Adler E, Camici P, Frigerio M, Sinagra G. C65 POST–DISCHARGE ARRHYTHMIC RISK STRATIFICATION OF PATIENTS WITH ACUTE MYOCARDITIS AND LIFE–THREATENING VENTRICULAR TACHYARRHYTHMIAS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
The outcomes of patients presenting with acute myocarditis and life–threatening ventricular arrhythmias (LT–VA) are unclear. The aim of this study was to assess the incidence and predictors of recurrent major arrhythmic events (MAEs) after hospital discharge in this patient population.
Methods and Results
We retrospectively analysed 156 patients (median age 44 years; 77% male) discharged with a diagnosis of acute myocarditis and LT–VA from 16 hospitals worldwide. Diagnosis of myocarditis was based on histology or the combination of increased markers of cardiac injury and cardiac magnetic resonance (CMR) Lake Louise criteria. MAEs were defined as the relapse, after discharge, of sudden cardiac death or successfully defibrillated ventricular fibrillation, or sustained ventricular tachycardia (sVT) requiring implantable cardioverter–defibrillator therapy or synchronized external cardioversion. Median follow–up was 23months [first to third quartile (Q1–Q3) 7–60]. Fifty–eight (37.2%) patients experienced MAEs after discharge, at a median of 8 months (Q1–Q3 2.5–24.0 months; 60.3% of MAEs within the first year). At multivariable Cox analysis, variables independently associated with MAEs were presentation with sVT [hazard ratio (HR) 2.90, 95% confidence interval (CI) 1.38–6.11]; late gadolinium enhancement involving ≥2 myocardial segments (HR 4.51, 95% CI 2.39–8.53), and absence of positive short–tau inversion recovery (STIR) (HR 2.59, 95% CI 1.40–4.79) at first CMR.
Conclusions
In this international multicentre study, patients discharged free from HTx or LVAD after an acute myocarditis complicated by LT–VA had a recurrence of MAEs during follow–up of 37.2%, after a median time of 8 months. Initial CMR pattern and sVT at presentation stratify the risk of arrhythmia recurrence.
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Affiliation(s)
- P Gentile
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - M Merlo
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - G Peretto
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - E Ammirati
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - S Sala
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - P Della Bella
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - G Aquaro
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - M Imazio
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - L Potena
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - J Campodonico
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - A Foà
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - A Raafs
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - M Hazebroek
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - M Brambatti
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - A Cercek
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - G Nucifora
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - S Shrivastava
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - F Huang
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - M Schmidt
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - D Muser
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - C Van De Heyning
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - E Van Craenenbroeck
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - T Aoki
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - K Sugimura
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - H Shimokawa
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - A Cannatà
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - J Artico
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - A Porcari
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - M Colopi
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - R Bussani
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - G Barbati
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - A Garascia
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - M Cipriani
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - P Agostoni
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - N Pereira
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - S Heymans
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - E Adler
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - P Camici
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - M Frigerio
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - G Sinagra
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
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Lorini L, Conforti E, Frigerio M, Laini L, Amoroso V, Alberti A, Schivardi G, Di Mauro P, Cosentini D, Vassalli L, Cremaschi V, Esposito A, Simoncini E, Gasparotti R, Berruti A, Pedersini R. 200P Increase of vertebral fractures in patients with metastatic breast cancer treated with endocrine therapy combined with CDK 4/6 inhibitor. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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D'Alessandro G, Palmieri S, Cola A, Barba M, Manodoro S, Frigerio M. Correlation between urinary symptoms and urodynamic findings: Is the bladder an unreliable witness? Eur J Obstet Gynecol Reprod Biol 2022; 272:130-133. [PMID: 35305346 DOI: 10.1016/j.ejogrb.2022.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/12/2022] [Accepted: 03/11/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The role of urodynamics as the gold standard to investigate bladder function has recently been questioned. We aimed to evaluate the agreement of lower urinary tract symptoms and urodynamic diagnosis and to build predictive models. STUDY DESIGN Patients who underwent urodynamics for pelvic floor disorders between 2008 and 2016 were retrospectively analyzed. Clinical evaluation investigated the presence of genital prolapse, stress urinary incontinence (SUI), overactive bladder (OAB), urge urinary incontinence (UUI), voiding symptoms (VS), and bulging symptoms. The degree of concordance/agreement between symptoms and corresponding urodynamic findings was measured. Multivariate models to predict specific urodynamic findings were built. RESULTS 1972 women were analyzed. The best agreement was found for SUI and urodynamic SUI, with a proportion of agreement of 0.68 and a Cohen's Kappa of 0.37. Very poor agreement was found for OAB/UUI and detrusor overactivity, voiding dysfunction, and positive post-void residuals. Multivariate models resulted in poor accuracy for all urodynamic findings (AUC range 0.64-0.72). CONCLUSION Lower urinary tract symptoms and gynecological examination are poor predictors of urodynamic findings. This confirms the role of urodynamic assessment in defining bladder function and providing precious information to counsel patients and establishing optimal clinical guidance.
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Affiliation(s)
- Gloria D'Alessandro
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Alice Cola
- University of Milano-Bicocca, Monza, Italy
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Frigerio M, Barba M, Cola A, Braga A, Celardo A, Munno GM, Schettino MT, Vagnetti P, De Simone F, Di Lucia A, Grassini G, Torella M. Quality of Life, Psychological Wellbeing, and Sexuality in Women with Urinary Incontinence—Where Are We Now: A Narrative Review. Medicina (B Aires) 2022; 58:medicina58040525. [PMID: 35454364 PMCID: PMC9025831 DOI: 10.3390/medicina58040525] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 11/16/2022] Open
Abstract
Urinary incontinence (UI) is a very common condition, negatively affecting social, occupational, domestic, and psychophysical wellbeing. In particular, a peculiar and detrimental effect of UI has been described concerning sexual function. However, the impact of UI on quality of life is not fully understood yet, and further investigation into this issue is warranted. With this narrative review, we aimed to report the current evidence from recent literature regarding the quality of life and psychological wellbeing in patients with urinary incontinence, with a special focus on sexual function and its evolution after UI treatment. There is strong evidence that urinary incontinence—in its different forms, including stress urinary incontinence, urge urinary incontinence, mixed urinary incontinence, and coital urinary incontinence—negatively affects female sexual function. Treatments aimed to cure urinary incontinence—including pelvic floor muscles training, medications, and surgery—seem to improve quality of life by recovering, at least in part, sexual function. In conclusion, there is a substantial association between involuntary urinary loss and sex life quality. However, few studies are available and more evidence is needed before consistent conclusions can be made.
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Affiliation(s)
- Matteo Frigerio
- Gynecology Department, San Gerardo Hospital, Milano Bicocca University, ASST Monza—Via Pergolesi 33, 20900 Monza, Italy; (M.B.); (A.C.)
- Correspondence: ; Tel.: +39-039-233-9434
| | - Marta Barba
- Gynecology Department, San Gerardo Hospital, Milano Bicocca University, ASST Monza—Via Pergolesi 33, 20900 Monza, Italy; (M.B.); (A.C.)
| | - Alice Cola
- Gynecology Department, San Gerardo Hospital, Milano Bicocca University, ASST Monza—Via Pergolesi 33, 20900 Monza, Italy; (M.B.); (A.C.)
| | - Andrea Braga
- Ospedale Regionale di Mendrisio Beata Vergine, 6850 Mendrisio, Switzerland;
| | - Angela Celardo
- Gynecology Department, Campania Luigi Vanvitelli University, 81100 Naples, Italy; (A.C.); (G.M.M.); (M.T.S.); (P.V.); (F.D.S.); (A.D.L.); (G.G.); (M.T.)
| | - Gaetano Maria Munno
- Gynecology Department, Campania Luigi Vanvitelli University, 81100 Naples, Italy; (A.C.); (G.M.M.); (M.T.S.); (P.V.); (F.D.S.); (A.D.L.); (G.G.); (M.T.)
| | - Maria Teresa Schettino
- Gynecology Department, Campania Luigi Vanvitelli University, 81100 Naples, Italy; (A.C.); (G.M.M.); (M.T.S.); (P.V.); (F.D.S.); (A.D.L.); (G.G.); (M.T.)
| | - Primo Vagnetti
- Gynecology Department, Campania Luigi Vanvitelli University, 81100 Naples, Italy; (A.C.); (G.M.M.); (M.T.S.); (P.V.); (F.D.S.); (A.D.L.); (G.G.); (M.T.)
| | - Fulvio De Simone
- Gynecology Department, Campania Luigi Vanvitelli University, 81100 Naples, Italy; (A.C.); (G.M.M.); (M.T.S.); (P.V.); (F.D.S.); (A.D.L.); (G.G.); (M.T.)
| | - Alessandra Di Lucia
- Gynecology Department, Campania Luigi Vanvitelli University, 81100 Naples, Italy; (A.C.); (G.M.M.); (M.T.S.); (P.V.); (F.D.S.); (A.D.L.); (G.G.); (M.T.)
| | - Giulia Grassini
- Gynecology Department, Campania Luigi Vanvitelli University, 81100 Naples, Italy; (A.C.); (G.M.M.); (M.T.S.); (P.V.); (F.D.S.); (A.D.L.); (G.G.); (M.T.)
| | - Marco Torella
- Gynecology Department, Campania Luigi Vanvitelli University, 81100 Naples, Italy; (A.C.); (G.M.M.); (M.T.S.); (P.V.); (F.D.S.); (A.D.L.); (G.G.); (M.T.)
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Ruffolo AF, Braga A, Torella M, Frigerio M, Cimmino C, De Rosa A, Sorice P, Castronovo F, Salvatore S, Serati M. Vaginal Laser Therapy for Female Stress Urinary Incontinence: New Solutions for a Well-Known Issue. A Concise Review. Medicina (B Aires) 2022; 58:medicina58040512. [PMID: 35454351 PMCID: PMC9028572 DOI: 10.3390/medicina58040512] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/25/2022] [Accepted: 04/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background and Objectives: Insufficient connective urethra and bladder support related to childbirth and menopausal estrogen decrease leads to stress urinary incontinence (SUI). The aim of this review is to narratively report the efficacy and safety of new mini-invasive solutions for SUI treatment as laser energy devices, in particular, the microablative fractional carbon dioxide laser and the non-ablative Erbium-YAG laser. Materials and Methods: For this narrative review, a search of literature from PubMed and EMBASE was performed to evaluate the relevant studies and was limited to English language articles, published from January 2015 to February 2022. Results: A significant subjective improvement, assessed by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF) was reported at the 6-month follow up, with a cure rate ranged from 21% to 38%. A reduction of effect was evidenced between 6 and 24–36 months. Additionally, the 1-h pad weight test evidence a significant objective improvement at the 2–6-month follow up. Conclusions: SUI after vaginal laser therapy resulted statistically improved in almost all studies at short-term follow up, resulting a safe and feasible option in mild SUI. However, cure rates were low, longer-term data actually lacks and the high heterogeneity of methods limits the general recommendations. Larger RCTs evaluating long-term effects are required.
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Affiliation(s)
- Alessandro Ferdinando Ruffolo
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milan, Italy; (A.F.R.); (S.S.)
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland; (A.B.); (F.C.)
| | - Marco Torella
- Department of Obstetrics and Gynecology, Second Faculty, 80100 Naples, Italy;
| | | | - Chiara Cimmino
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.C.); (A.D.R.); (P.S.)
| | - Andrea De Rosa
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.C.); (A.D.R.); (P.S.)
| | - Paola Sorice
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.C.); (A.D.R.); (P.S.)
| | - Fabiana Castronovo
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland; (A.B.); (F.C.)
| | - Stefano Salvatore
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milan, Italy; (A.F.R.); (S.S.)
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.C.); (A.D.R.); (P.S.)
- Correspondence: ; Tel.: +39-03-3229-9309
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Frigerio M, Inzoli A, Barba M. Pelvic organ prolapse and vaginal cancer: a systematic literature review. Int J Gynaecol Obstet 2022; 159:365-371. [PMID: 35167139 DOI: 10.1002/ijgo.14137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/29/2022] [Accepted: 02/09/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Primary vaginal cancer is a rare gynecologic malignancy. Few cases about the concurrence of a vaginal tumor with advanced genital prolapse are reported in the literature and there is no consensus on optimal treatment. OBJECTIVES To investigate available evidence on presentation, treatment, and outcomes of these concurrent conditions. SEARCH STRATEGY We performed a systematic search of literature indexed on PubMed, Scopus, ISI Web of Science, Cochrane using a combination of keywords and text words represented by a combination of keywords and text words represented by "pelvic organ prolapse", "genital prolapse" and "vaginal cancer", "vaginal carcinoma" SELECTION CRITERIA: No article type restrictions were applied. DATA COLLECTION AND ANALYSIS Twenty-one studies (case reports and two small case series) were incorporated into the review process, for a total of 27 patients MAIN RESULTS: Management usually involved surgery or primary external beam radiation therapy. External beam radiation therapy was reported to be highly associated with the development of vesicovaginal fistula. The surgical approach was the treatment of choice in most cases. On the contrary, exclusive interstitial brachytherapy was rarely performed. CONCLUSIONS A multidisciplinary approach considering risks and benefits is of the utmost importance to provide counseling and tailor treatment strategy in these complex cases.
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Cola A, Marino G, Milani R, Barba M, Volontè S, Spelzini F, Manodoro S, Frigerio M. Native-tissue prolapse repair: efficacy and adverse effects of uterosacral ligaments suspension at 10-year follow up. Int J Gynaecol Obstet 2022; 159:97-102. [PMID: 35044675 PMCID: PMC9544876 DOI: 10.1002/ijgo.14096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/18/2021] [Accepted: 01/12/2022] [Indexed: 11/24/2022]
Abstract
Objective To evaluate the 10‐year outcomes of high uterosacral ligaments suspension as a primary repair for apical prolapse and to evaluate the long‐term impact of prognostic factors. Methods A retrospective study analyzed 10‐year follow up after repair of primary apical prolapse through high uterosacral ligament suspension. Bulging symptoms and postoperative prolapse stage II or above were considered subjective and objective recurrences, respectively. Patient Global Impression of Improvement score was used to evaluate subjective satisfaction after surgery. Results A total of 287 women were analyzed. Ten‐year recurrence rates were 19.1% for objective recurrence and 6.3% for subjective recurrence; surgical retreatment rate was 2.1%. Premenopausal status was related to 15‐fold increased risk of developing either objective or subjective recurrence. Conversely, anterior and posterior repair were protective factors against reoperation. Conclusion High uterosacral ligaments suspension is a safe and long‐lasting effective procedure for the treatment of uterovaginal prolapse even 10 years after index surgery. Premenopausal status and lack of anterior and posterior repair represented long‐term risk factors for surgical failure.
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Barba M, Lazar T, Cola A, Marino G, Manodoro S, Frigerio M. Learning Curve of Botulinum Toxin Bladder Injection for the Treatment of Refractory Overactive Bladder. Int J Womens Health 2022; 14:1-7. [PMID: 35018123 PMCID: PMC8742680 DOI: 10.2147/ijwh.s345454] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/22/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Intradetrusor botulinum toxin injections is an established second-line treatment for patients with refractory overactive bladder syndrome (OAB). We aimed to evaluate the learning curve of intradetrusor injections with botulinum toxin for the treatment of refractory OAB. PATIENTS AND METHODS This retrospective study analyzed all women with idiopathic and refractory OAB who underwent botulinum toxin bladder injections performed by residents with no previous experience with operative cystoscopy under consultant supervision. Baseline International Consultation on Incontinence Questionnaire-Short Form questionnaire (ICIQ-SF) and Euroqol (EQ-5D) questionnaires were collected. Procedural data (operative time, number of valid injections, complications, subjective easiness, perceived tolerability) and patients' outcomes (Patients Global Impression of Improvement (PGI-I), ΔICIQ-SF, ΔEQ-5D, need for self intermittent catheterization, duration of efficacy) were considered as markers to evaluate learning curves for each resident. RESULTS Twenty-seven patients underwent intravesical injection of botulinum toxin performed by residents. Only a grade 1 Clavien-Dindo complication occurred, and none of the patients had urinary retention. PGI-I was very satisfactory, scoring 1.4 ± 0.9. Both ICIQ-SF and EQ-5D 2-2 were statistically improved (p < 0.00001 and p = 0.04, respectively). The mean duration of efficacy resulted to be 8.0±4.3 months. A positive effect of the learning curve was observed only for operative time, subjective easiness, and perceived tolerability. CONCLUSION Intradetrusor botulinum toxin injection for the treatment of refractory OAB is characterized by high efficacy and very low complications even at the very beginning of the learning curve when performed under proper mentorship.
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Affiliation(s)
- Marta Barba
- University Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Tetyana Lazar
- University Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Alice Cola
- University Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Giuseppe Marino
- University Milano-Bicocca, San Gerardo Hospital, Monza, Italy
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